Examination and Treatment Methods in Dogs and Cats 2nd Edition [16mb]

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EXAMINATION AND TREATMENT METHODS IN DOGS AND CATS

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Examination and Treatment Methods in Dogs and Cats 2nd edition Christian F. Schrey Translated by Heidi Joeken

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To the three bright sparks in my life, giving me perspective: Sabiene, Noona and Philipp

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Acknowledgements

Every day I use this book at least once to check upon or find something quickly. It looks battered, discoloured and well-thumbed and lives on a shelf in our practice. It is with great delight that I found this book in veterinary practices around the world in exactly this condition. My thanks go to Dr Sabine Schmidt, Pippo Farnedi, Dr Karl-Heinz Kirschstein, Oliver Cescotti, Nicolai Hildebrand, Dr Johann Homm, Dr Frank-Ullrich Hügel, Alexander Hüttig, Dr Kirsten Peters, Schwester Andrea from the hospital Waldfriede in Berlin, Dr Bernhard Sörensen, Hayden Yates and to the staff at Schattauer Publishers, in particular to Dr Wulf Bertram and Dr Petra Mülker. With their help we managed to create a handbook for the most often required working techniques in the daily lives of the small animal practitioner. Dr Med Vet Christian F. Schrey Berlin, August 2013

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Contents

PART I: EXAMINATION METHODS ........................................... xiv 1 General Examination Methods .............................................. 1 Restraining the Patient ................................................................ 1 Blood Sampling: Venous Blood Sampling ................................. 11 Blood Sampling: Arterial Blood Sampling .................................. 14

2 Sample Processing ................................................................ 16 Blood Sample............................................................................. 16 Paracentesis ................................................................................ 20 Fine Needle Aspiration Biopsy ................................................... 23 Tissue Sample (Biopsy)............................................................... 26 Swab Sample.............................................................................. 29 Skin Scrape ................................................................................ 32 Impression Smear/Skin Scrape ................................................... 35 Hair Sample ............................................................................... 38 Urine Sample............................................................................. 40 Faecal Sample............................................................................. 46

3 Cardiological Examination Methods................................... 50 Case History .............................................................................. 50 Inspection .................................................................................. 50 Palpation.................................................................................... 52 Auscultation............................................................................... 57 X-Ray Study ............................................................................. 63 Electrocardiography (ECG) ........................................................ 71 Ultrasound Examination ............................................................ 88 Blood Pressure Measurement ................................................... 105 Measuring the Central Venous Pressure.................................... 106 Thoracocentesis........................................................................ 109 Pericardiocentesis ..................................................................... 111 Abdominocentesis .................................................................... 113 Further Cardiological Examination Methods ............................ 114

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viii

CONTENTS

4 Respiratory Examination Methods .................................... 115 Case History ............................................................................ 115 Inspection ................................................................................ 115 Palpation.................................................................................. 117 Percussion ................................................................................ 118 Auscultation ............................................................................. 122 X-Ray Study ........................................................................... 124 Endoscopy ............................................................................... 129 Laryngoscopy ........................................................................... 133 Tracheo-/Bronchoscopy .......................................................... 135 Biopsy of the Nasal Mucosa ..................................................... 138 Biopsy of the Tracheal/Bronchial Mucosa ................................ 140 Biopsy of the Lung................................................................... 141 Endotracheal Lavage................................................................. 145 Transtracheal Lavage ................................................................ 149 Thoracocentesis........................................................................ 151 Further Respiratory Examination Methods............................... 152

5 Gastrointestinal Examination Methods ............................ 153 Case History ............................................................................ 153 Inspection ................................................................................ 153 Palpation.................................................................................. 157 Percussion ................................................................................ 163 Auscultation ............................................................................. 164 Plain X-Ray Study................................................................... 165 Gastrointestinal Contrast Medium Study .................................. 173 Gastroscopy.............................................................................. 176 Coloscopy................................................................................ 180 Ultrasound Examination: Abdomen ......................................... 183 Lymph Node Biopsy ................................................................ 187 Tumour Biopsy........................................................................ 188 Liver Biopsy............................................................................. 189 Gastric/Intestinal Biopsy .......................................................... 190 Rectal Swab Sample................................................................. 192 Abdominocentesis .................................................................... 193 Further Gastrointestinal Examination Methods ......................... 194

6 Urological Examination Methods ...................................... 195 Case History ............................................................................ 195

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CONTENTS

ix

Inspection ................................................................................ 195 Palpation.................................................................................. 196 Plain X-Ray Study................................................................... 198 Contrast Medium Study ........................................................... 202 Endoscopy: Urethro-Cystoscopy.............................................. 206 Ultrasound Examination........................................................... 206 Biopsy of the Urinary Bladder .................................................. 211 Biopsy of the Kidney................................................................ 214 Urinary Catheter: Male Dog .................................................... 215 Urinary Catheter: Male Cat...................................................... 217 Urinary Catheter: Female Dog and Cat .................................... 218 Cystocentesis............................................................................ 221 Abdominocentesis .................................................................... 223 Further Urological Examination Methods ................................ 224

7 Gynaecological Examination Methods............................. 225 Case History ............................................................................ 225 Inspection ................................................................................ 225 Palpation.................................................................................. 227 X-Ray Study ........................................................................... 229 Endoscopy: Vaginoscopy.......................................................... 231 Ultrasound Examination........................................................... 232 Biopsy: Vaginal Smear.............................................................. 235 Further Gynaecological Examination Methods ......................... 235

8 Andrological Examination Methods.................................. 236 Case History ............................................................................ 236 Inspection ................................................................................ 236 Palpation.................................................................................. 238 X-Ray Study ........................................................................... 240 Ultrasound Examination........................................................... 241 Biopsy: Fine Needle Aspiration Biopsy..................................... 243

9 Orthopaedic Examination Methods ................................... 244 Case History ............................................................................ 244 Inspection ................................................................................ 244 Palpation: Skull ........................................................................ 246 Palpation: Spine ....................................................................... 247 Palpation: Forelimb .................................................................. 249

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CONTENTS

Palpation: Hind Limb............................................................... 254 X-Ray Study: Skull.................................................................. 265 X-Ray Study: Spine................................................................. 267 X-Ray Study: Forelimb ........................................................... 270 X-Ray Study: Hind Limb ........................................................ 273 Endoscopy: Arthroscopy .......................................................... 298 Ultrasound Examination........................................................... 303 Joint Biopsy ............................................................................. 304 Bone Marrow Biopsy ............................................................... 305 Bone Biopsy............................................................................. 309 Arthrocentesis .......................................................................... 311 Further Orthopaedic Examination Methods ............................. 313

10 Neurological Examination Methods ................................. 314 Case History ............................................................................ 314 Inspection ................................................................................ 315 Palpation.................................................................................. 317 Postural Responses ................................................................... 319 Spinal Reflexes......................................................................... 324 Cranial Nerves ......................................................................... 330 Sensory Perception................................................................... 340 Plain X-Ray Study................................................................... 344 Myelography............................................................................ 348 Cerebrospinal Fluid Puncture/CSF Tap ................................... 350 Further Neurological Examination Methods............................. 355

11 Ophthalmological Examination Methods ......................... 356 Case History ............................................................................ 356 Inspection ................................................................................ 356 Sight Test................................................................................. 359 Reflexes................................................................................... 361 Penlight Examination............................................................... 363 Schirmer Tear Test .................................................................. 364 Taking a Swab Sample ............................................................. 365 Fluorescein Test ....................................................................... 366 Eversion of the Nictitating Membrane ..................................... 367 Gonioscopy.............................................................................. 368 Tonometry............................................................................... 370 Flushing of the Nasolacrimal Duct............................................ 372 Examinations During Pupillary Dilatation: Ophthalmoscopy .... 373

CONTENTS

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X-Ray Study ........................................................................... 378 Ultrasound Examination........................................................... 379 Biopsy...................................................................................... 381 Further Ophthalmological Examination Methods ..................... 383

12 Otological Examination Methods ...................................... 384 Case History ............................................................................ 384 Inspection ................................................................................ 384 Olfactory Test .......................................................................... 387 Otoscopy ................................................................................. 388 X-Ray Study ........................................................................... 390 Biopsy...................................................................................... 391 Hearing Test ............................................................................ 392 Further Otological Examination Methods ................................ 393

13 Dermatological Examination Methods ............................. 393 Case History ............................................................................ 393 Inspection ................................................................................ 393 Palpation.................................................................................. 401 Olfactory Test .......................................................................... 403 Flea Check with Flea Comb..................................................... 404 Wood-Lamp Examination........................................................ 405 Skin Scrape .............................................................................. 406 Swab Sample............................................................................ 408 Sticky Tape Impression Smear.................................................. 409 Hair Pluck Sample ................................................................... 410 Skin Punch Biopsy ................................................................... 411 Fine Needle Biopsy.................................................................. 412 Further Dermatological Examination Methods ......................... 413

PART II: TREATMENT METHODS ............................................. 414 14 Injection .................................................................................. 415 Subcutaneous Injection ............................................................ 415 Intramuscular Injection ............................................................ 417 Intravenous Injection ............................................................... 421 Intraperitoneal Injection ........................................................... 424 Intracardiac Injection................................................................ 425

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CONTENTS

Intraarticular Injection.............................................................. 426 Injection at the Bicipital Tendon.............................................. 429 Eye injection: Subconjunctival Injection .................................. 430 Eye injection: Injection into the Chamber of the Eye............... 431

15 Venous Access ...................................................................... 433 Peripheral Venous Catheter...................................................... 433 Central Venous Catheter.......................................................... 437 Intraosseal Access ..................................................................... 450

16 Infusion.................................................................................... 453 Intravenous Infusion (gravity assisted) ....................................... 453 Subcutaneous Infusion Therapy................................................ 457 Infusion Pump ......................................................................... 460 Syringe Driver.......................................................................... 464

17 Transfusion............................................................................. 467 Full Blood Transfusion ............................................................. 467 Preparation of Preserved Blood Units....................................... 477 Autotransfusion ........................................................................ 479

18 Inhalation................................................................................ 482 Oxygen Supplementation......................................................... 482 Endotracheal Intubation ........................................................... 484 Tracheotomy ........................................................................... 489 Inhalation Therapy................................................................... 492

19 Parenteral Nutrition.............................................................. 493 Pharyngostomy Tube ............................................................... 493 Percutaneous Endoscopic Gastrostomy (PEG Tube) ................. 495 Nasogastric Tube ..................................................................... 499

20 Urinary Catheter .................................................................... 500 Urethral Catheter ..................................................................... 500 Prepubic Urinary Catheter ....................................................... 505

CONTENTS

xiii

21 Drainage.................................................................................. 508 Thoracocentesis/Thoracic Drainage ......................................... 508 Pericardiocentesis/Pericardial Drainage..................................... 512 Abdominocentesis/Abdominal Drainage................................... 518 Paracentesis .............................................................................. 521

22 Flushes .................................................................................... 523 Nasal Flush............................................................................... 523 Nasolacrimal Duct Flush .......................................................... 526 Ear Flush.................................................................................. 528 Peritoneal Lavage ..................................................................... 531 Gastric Lavage .......................................................................... 533 Colonic Lavage ........................................................................ 534 Anal Sac Lavage ....................................................................... 536 Urethral Lavage........................................................................ 538

23 Bandages ................................................................................ 542 Ruff ......................................................................................... 542 Spray/Plaster/Stulpa Dressing................................................... 543 Ear Dressing............................................................................. 544 Head/Neck Dressing................................................................ 547 Thoracic Dressing .................................................................... 548 Abdominal Dressing ................................................................. 549 Tail Dressing ............................................................................ 550 Bandage for the Fore Limb....................................................... 551 Bandage for the Hind Limb...................................................... 553 Elbow Dressing ........................................................................ 555 Stifle Dressing .......................................................................... 556 Robert-Jones Dressing ............................................................. 557 Elastic Bandage ........................................................................ 558 Splint Bandage ......................................................................... 560 Schröder-Thomas Dressing ...................................................... 563 Ehmer-Sling Bandage............................................................... 564 Velpeau-Sling Bandage............................................................. 566 Robinson-Sling Bandage.......................................................... 567 Hoppel-Sling Bandage ............................................................. 568

Index .............................................................................................. 569

Part I

Examination Methods

xii

CONTENTS

Intraarticular Injection.............................................................. 426 Injection at the Bicipital Tendon.............................................. 429 Eye injection: Subconjunctival Injection .................................. 430 Eye injection: Injection into the Chamber of the Eye............... 431

15 Venous Access ...................................................................... 433 Peripheral Venous Catheter...................................................... 433 Central Venous Catheter.......................................................... 437 Intraosseal Access ..................................................................... 450

16 Infusion.................................................................................... 453 Intravenous Infusion (gravity assisted) ....................................... 453 Subcutaneous Infusion Therapy................................................ 457 Infusion Pump ......................................................................... 460 Syringe Driver.......................................................................... 464

17 Transfusion............................................................................. 467 Full Blood Transfusion ............................................................. 467 Preparation of Preserved Blood Units....................................... 477 Autotransfusion ........................................................................ 479

18 Inhalation................................................................................ 482 Oxygen Supplementation......................................................... 482 Endotracheal Intubation ........................................................... 484 Tracheotomy ........................................................................... 489 Inhalation Therapy................................................................... 492

19 Parenteral Nutrition.............................................................. 493 Pharyngostomy Tube ............................................................... 493 Percutaneous Endoscopic Gastrostomy (PEG Tube) ................. 495 Nasogastric Tube ..................................................................... 499

20 Urinary Catheter .................................................................... 500 Urethral Catheter ..................................................................... 500 Prepubic Urinary Catheter ....................................................... 505

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EXAMINATION METHODS

Fig 1.5 Double lead

Fig 1.6 Feeding the lead under a door

Method • Mouth sling – Place a prepared gauze loop over the muzzle – Cross over the ties underneath the throat – Tie the ends behind the ears • Muzzle – Choose the appropriate size – To be fitted by the owner – Close the ties behind the ears • Double lead – Immobilisation of the dog between two leads • Feeding lead under door – Owner leaves the room with dog on the lead – Closure of the door between owner and dog – Lead is fed under the door and pulled tight (take care)

GENERAL EXAMINATION METHODS

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Restraining Methods in the Cat

Fig 1.7 Crush cage

Fig 1.8 Strait jacket or sack

Fig 1.9 Towel

Method • Crush cage – Preparation: assemble the pushing wall and the rod – Tip the cat out of its transport box into the crush cage (cover the sides with towels) – Close the cage door in a coordinated manner – Restrain the cat between the mobile pushing and side wall • Strait jacket or sac • Towel – Suitable for manipulation by the owners – Immobilise the cat between your knees and closed ankles while kneeling – Place the towel around the neck and front legs of the cat

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EXAMINATION METHODS

Transport

Fig 1.10 Trolley with stretcher

Fig 1.11 Being carried by one person

Fig 1.12 Being carried by two people

Fig 1.13 Carrying of a relaxed cat

Fig 1.14 Carrying a cat safely

GENERAL EXAMINATION METHODS

Lifting

Fig 1.15 Lifting by one person

Fig 1.16 Lifting by two people

Holding the dog

Fig 1.17 Holding while the dog is standing (one person)

Fig 1.18 Holding while the dog is standing (two people)

Fig 1.19 Holding while the dog is sitting

Fig 1.20 Holding while the dog is in lateral recumbency

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EXAMINATION METHODS

Fig 1.21

Fig 1.22

Fig 1.23 Holding whilst examining the ear

Fig 1.24 Restraining the head

Fig 1.25 Holding while examining the perineum

Fig 1.26 Holding for blood sampling (standing or sitting)

GENERAL EXAMINATION METHODS

Lifting

Fig 1.15 Lifting by one person

Fig 1.16 Lifting by two people

Holding the dog

Fig 1.17 Holding while the dog is standing (one person)

Fig 1.18 Holding while the dog is standing (two people)

Fig 1.19 Holding while the dog is sitting

Fig 1.20 Holding while the dog is in lateral recumbency

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EXAMINATION METHODS

Holding the Cat

Fig 1.32 Holding while the cat is standing

Fig 1.33 Holding in sternal position

Fig 1.34 Holding in lateral recumbency (two people)

Fig 1.35 Holding in lateral recumbency (one person)

Fig 1.36 Holding in dorsal position (two people)

Fig 1.37 Holding in dorsal position (one person)

GENERAL EXAMINATION METHODS

Fig 1.38 Holding for blood sampling (cephalic vein)

Fig 1.39 Holding for blood sampling (cephalic vein)

Fig 1.40 Holding for blood sampling (back leg)

Fig 1.41 Holding for blood sampling (back leg)

Fig 1.42 Holding for jugular blood sampling

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EXAMINATION METHODS

Lying Down

Fig 1.43 Lift and rotate into lateral position

Fig 1.44 Lay the patient down gently on his side

Fig 1.45 Readjust the holding hands to keep the patient down

Fig 1.46 Lift and rotate into lateral position

Fig 1.47 Lay the patient down gently

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EXAMINATION METHODS

Lying Down

Fig 1.43 Lift and rotate into lateral position

Fig 1.44 Lay the patient down gently on his side

Fig 1.45 Readjust the holding hands to keep the patient down

Fig 1.46 Lift and rotate into lateral position

Fig 1.47 Lay the patient down gently

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EXAMINATION METHODS

Venous Blood Sampling in the Cat

Fig 1.52 Puncture of the cephalic vein of the forelimb (1)

Fig 1.53 Puncture of the cephalic vein of the forelimb (2)

Fig 1.54 Puncture of the medial saphenous vein (1)

Fig 1.55 Puncture of the medial saphenous vein (2)

GENERAL EXAMINATION METHODS

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Method • Preparation – Position of the patient: standing (dog); sitting/sternal (cat) – Separate/clip fur – Disinfect skin Venous stasis (manual/tourniquet) – Accessible veins for blood sampling in the dog – Cephalic vein of the forelimb – Lateral saphenous vein (external jugular vein) Accessible veins for blood sampling in the cat – Cephalic vein of the forelimb – Medial saphenous vein – External jugular vein • Technique Fixation of the vein – Method 1: between thumb and middle finger – Method 2: lateral fixation with thumb Venous puncture – Nearly tangential puncture through the skin and venous wall – Further insertion of the cannula into the venous lumen – Fixation of the cannula between thumb and middle finger of the left hand Blood taking – Allow the blood to drop into blood tubes – Close the blood tubes and swill gently (EDTA/Heparin/Citrate) – Release the venous stasis – Remove the cannula and apply pressure with a swab – Light dressing/swab cover Complications • • • •

Paravascular malpuncture Haematoma Thrombophlebitis Air embolism

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EXAMINATION METHODS

Blood Sampling: Arterial Blood Sampling Indication • Blood gas analysis (BGA) Arterial Blood Sampling in the Dog

Fig 1.56 Puncture of the femoral artery (1)

Fig 1.57 Puncture of the femoral artery (2)

Vein Artery

Fig 1.58 Puncture of the dorsal artery of the foot

Fig 1.59 Airtight closure of the syringe

GENERAL EXAMINATION METHODS

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Method • Preparation – Flush a syringe with heparin – Position of patient: lateral recumbency – Clip fur and disinfect skin • Technique Palpation of the pulse – Fixation of artery – Fixation between the index and middle finger Puncture of the femoral artery – Syringe with attached cannula – Puncture the skin and arterial wall while slightly aspirating (c. 45°) until bright red pulsating blood flows in – IVAN (inside – vein – artery – nerve) Puncture of the dorsal artery of the foot – Syringe with attached cannula – Puncture the skin and arterial wall whilst slightly aspirating (c. 20°) until bright red pulsating blood flows in – Dorsal superficial artery is distal end of the hock slightly medial of the midline Blood sampling – Remove the cannula and apply pressure with swab – Compression (c. 5 min) – Light dressing/swab cover • Sample processing – Removal of air bubbles – Puncture of a rubber bung with the cannula for airtight closure – Immediate processing of blood sample Complications • • • •

Paravascular malpuncture Accidental puncture of the femoral vein (dark blood, no pulsation) Damage to the femoral nerve Haematoma/abscess

GENERAL EXAMINATION METHODS

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Method • Preparation – Flush a syringe with heparin – Position of patient: lateral recumbency – Clip fur and disinfect skin • Technique Palpation of the pulse – Fixation of artery – Fixation between the index and middle finger Puncture of the femoral artery – Syringe with attached cannula – Puncture the skin and arterial wall while slightly aspirating (c. 45°) until bright red pulsating blood flows in – IVAN (inside – vein – artery – nerve) Puncture of the dorsal artery of the foot – Syringe with attached cannula – Puncture the skin and arterial wall whilst slightly aspirating (c. 20°) until bright red pulsating blood flows in – Dorsal superficial artery is distal end of the hock slightly medial of the midline Blood sampling – Remove the cannula and apply pressure with swab – Compression (c. 5 min) – Light dressing/swab cover • Sample processing – Removal of air bubbles – Puncture of a rubber bung with the cannula for airtight closure – Immediate processing of blood sample Complications • • • •

Paravascular malpuncture Accidental puncture of the femoral vein (dark blood, no pulsation) Damage to the femoral nerve Haematoma/abscess

SAMPLE PROCESSING

Fig 2.5 Smear (3)

Fig 2.6 Leave the sample to dry

Fig 2.7 Fixate and stain

Fig 2.8 Rinse

Fig 2.9 Dry

Fig 2.10 Microscopic examination

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EXAMINATION METHODS

Serum Tube

Fig 2.11 Leave the tube for 15–30 min

Fig 2.12 Centrifugation (c. 10 min. at 3,000 rpm)

Fig 2.13 Pipette the serum off

Fig 2.14 Blood chemistry analysis

SAMPLE PROCESSING

Blood Sample: EDTA Tube • Technique – – – –

Swill the tube gently after obtaining sample Measure the blood glucose immediately Differential blood count Haematological laboratory investigation

Blood Sample: Differential Blood Count • Technique – Transfer one drop of EDTA-blood onto a microscope slide – Approach the drop of blood with a cover slide (30–45°) – Push the cover slide after contact with the drop of blood swiftly along the microscope slide – Leave the smear to dry – Fixate and stain the smear – Rinse with water/distilled water – Leave the smear to dry in a tilted position – Perform a microscopic examination Blood Sample: Serum Tube • Technique – – – –

Leave the tube for 15–30 min at room temperature Centrifugation for c. 10 min at 3,000 rpm Pipette the serum off Blood chemistry analysis

Complications • Haemolysis • Microthrombi

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EXAMINATION METHODS

Paracentesis Indication • Thoracocentesis, Pericardiocentesis, Abdominocentesis, Tracheobronchial lavage, Nasal flush, Arthrocentesis, Cerebrospinal fluid puncture, CSF tap Paracentesis

Fig 2.15 Transfer the sample into a test tube

Fig 2.16 Dispatch the sample for laboratory analysis

Fig 2.17 Transfer the sample into a culture tube for bacteriological examination

Fig 2.18 Transfer the sample into a centrifugation tube for cytological examination of sediment

SAMPLE PROCESSING

Paracentesis: Examination of Sediment

Fig 2.19 Centrifugation (c. 10 min at 3,000 rpm)

Fig 2.20 Decant the supernatant fluid

Fig 2.21 Plump up the sediment

Fig 2.22 Pipette the sediment off

Fig 2.23 Transfer the sediment onto a microscope slide

Fig 2.24 Smear (1)

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EXAMINATION METHODS

Fig 2.25 Smear (2)

Fig 2.26 Dry

Fig 2.27 Fixate and stain

Fig 2.28 Rinse

Fig 2.29 Dry

Fig 2.30 Microscopic examination

SAMPLE PROCESSING

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Method • Technique: examination of the sediment – – – – – – – – – – –

Transfer the sample into a pointed centrifugation tube Centrifugation (c. 10 min at 3,000 rpm) Decant the supernatant fluid Plump up the sediment Pipette the sediment off and transfer it onto a microscope slide Make a smear Dry the smear Fixate and stain the smear Rinse the smear with water/distilled water Dry the smear in tilted position Perform a microscopic examination

Fine Needle Aspiration Biopsy Indication • Tumour biopsy, Lymph node biopsy, Liver biopsy, Bone marrow biopsy, Prostate biopsy Fine Needle Aspiration Biopsy

Fig 2.31 Transfer the sample to a microscope slide

Fig 2.32 Syringe/spray sample onto a microscope slide (bone marrow)

SAMPLE PROCESSING

Fig 2.39 Dry

Fig 2.40 Microscopic examination

Method • Technique – Transfer the sample onto a microscope slide Bone marrow – Spray the bone marrow out of the syringe onto a tilted microscope slide – Let the blood run off – Make a smear – Dry the smear – Fixate and stain the smear – Rinse the smear with water/distilled water – Dry the smear in a tilted position – Perform a microscopic examination

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SAMPLE PROCESSING

Fig 2.39 Dry

Fig 2.40 Microscopic examination

Method • Technique – Transfer the sample onto a microscope slide Bone marrow – Spray the bone marrow out of the syringe onto a tilted microscope slide – Let the blood run off – Make a smear – Dry the smear – Fixate and stain the smear – Rinse the smear with water/distilled water – Dry the smear in a tilted position – Perform a microscopic examination

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EXAMINATION METHODS

Tissue Sample (Biopsy) Indication • Skin punch biopsy, Tru-cut-organ/tumour biopsy, Endoscopic biopsy Tissue Sample

Fig 2.41 Transfer the sample from the biopsy forceps

Fig 2.42 Transfer the sample from the endoscopy forceps

Fig 2.43 Transfer the sample from the bone biopsy needle

Fig 2.44 Transfer the sample into a culture tube

SAMPLE PROCESSING

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Tissue Sample: Cytological Preparation

Fig 2.45 Cytological impression smear

Fig 2.46 Cytological crushing preparation

Fig 2.47 Dry

Fig 2.48 Fixate and stain

Fig 2.49 Rinse

Fig 2.50 Dry

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EXAMINATION METHODS

Fig 2.56 Dry

Fig 2.57 Microscopic examination

Fig 2.58 Transfer the sample into a culture tube (bacteriology)

Fig 2.59 Smear the swab onto a fungal culture medium (mycology)

SAMPLE PROCESSING

Swab Sample Indication • Nasal/pharyngeal/tracheal/conjunctival/skin/ear canal/vaginal/ preputial/rectal smear Swab Sample

Fig 2.52 Roll the swab sample onto a microscope slide

Fig 2.53 Dry

Fig 2.54 Fixate and stain

Fig 2.55 Rinse

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EXAMINATION METHODS

Fig 2.56 Dry

Fig 2.57 Microscopic examination

Fig 2.58 Transfer the sample into a culture tube (bacteriology)

Fig 2.59 Smear the swab onto a fungal culture medium (mycology)

SAMPLE PROCESSING

Cytology • Technique – – – – – – –

Make a smear Roll the smear onto a microscope slide Dry the smear Fixate and stain the smear Rinse the smear with water/distilled water Dry the smear in a tilted position Perform a microscopic examination

Bacteriology • Technique – Transfer the swab sample into a culture tube – Dispatch the sample Mycology • Technique – Smear the swab sample onto a fungal culture medium

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EXAMINATION METHODS

Parasitology • Technique – – – –

Apply a drop of paraffin onto a microscope slide Apply the sample onto the microscope slide Place a cover slide on top Perform a microscopic examination

Cytology • Technique – – – – – –

Apply and spread out the sample onto a microscope slide Dry the sample Fixate and stain the sample Rinse the sample with water/distilled water Dry the sample in a tilted position Perform a microscopic examination

SAMPLE PROCESSING

Skin Scrape: Cytological Examination

Fig 2.64 Apply and spread out the sample

Fig 2.65 Dry

Fig 2.66 Fixate and stain

Fig 2.67 Rinse

Fig 2.68 Dry

Fig 2.69 Microscopic examination

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EXAMINATION METHODS

Parasitology • Technique – – – –

Apply a drop of paraffin onto a microscope slide Apply the sample onto the microscope slide Place a cover slide on top Perform a microscopic examination

Cytology • Technique – – – – – –

Apply and spread out the sample onto a microscope slide Dry the sample Fixate and stain the sample Rinse the sample with water/distilled water Dry the sample in a tilted position Perform a microscopic examination

SAMPLE PROCESSING

Impression Smear/Skin Scrape Indication • Ulcerating Tumours, Eczema Impression Smear

Fig 2.70 Apply the sample directly onto a microscope slide

Fig 2.71 Dry

Fig 2.72 Fixate and stain

Fig 2.73 Rinse

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SAMPLE PROCESSING

Fig 2.83 Microscopic examination

Hair Sample: Fungal Culture

Fig 2.84 Transfer the hair sample onto a fungal culture medium

Fig 2.85 Transfer the hair sample onto a fungal culture medium

Hair Examination

Mycology

• Technique

• Technique

– Apply one drop of paraffin onto a microscope slide – Transfer the hair sample onto a microscope slide – Apply a cover slide – Perform a microscopic examination

– Transfer the hair sample onto a fungal culture medium

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SAMPLE PROCESSING

Fig 2.78 Microscopic examination

Sticky Tape Impression • Technique – – – –

Apply one drop of paraffin onto a microscope slide Dab the skin with some sticky tape Apply the sticky tape onto a microscope slide Perform a microscopic examination

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EXAMINATION METHODS

Hair Sample Indication • Alopecia, hair breakage • Dermatophytosis Hair Sample: Examination of the Hair

Fig 2.79 Apply one drop of paraffin to a microscope slide

Fig 2.80 Add the hair sample

Fig 2.81 Apply the hair sample from the flea comb

Fig 2.82 Add a cover slide

SAMPLE PROCESSING

Fig 2.83 Microscopic examination

Hair Sample: Fungal Culture

Fig 2.84 Transfer the hair sample onto a fungal culture medium

Fig 2.85 Transfer the hair sample onto a fungal culture medium

Hair Examination

Mycology

• Technique

• Technique

– Apply one drop of paraffin onto a microscope slide – Transfer the hair sample onto a microscope slide – Apply a cover slide – Perform a microscopic examination

– Transfer the hair sample onto a fungal culture medium

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EXAMINATION METHODS

Fig 2.107 Rinse

Fig 2.109 Microscopic examination

Fig 2.108 Dry

SAMPLE PROCESSING

Urine Examination: Refractometry

Fig 2.90 Take a sample for refractometry

Fig 2.91 Apply the sample onto the refractometer

Fig 2.92 Close the lid

Fig 2.93 Analysis

Fig 2.94 Evaluation scale

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EXAMINATION METHODS

Urine Examination: Bacteriological Culture and Examination of the Sediment

Fig 2.95 Bacteriological culture

Fig 2.96 Bacteriological culture

Fig 2.97 Centrifugation

Fig 2.98 Decant the supernatant

Fig 2.99 Plump up the sediment

Fig 2.100 Pipette the sediment off

SAMPLE PROCESSING

Urine Examination: Examination of the Sediment

Fig 2.101 Apply the sample onto a microscope slide

Fig 2.102 Apply a cover slide

Fig 2.103 Microscopic examination (crystals)

Fig 2.104 Remove the cover slide

Fig 2.105 Dry

Fig 2.106 Fixate and stain

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EXAMINATION METHODS

Fig 2.107 Rinse

Fig 2.109 Microscopic examination

Fig 2.108 Dry

SAMPLE PROCESSING

Urine Chemistry • Technique – Transfer the urine sample into a pointed centrifugation tube – Dip the test strip into the tube – Analyse the results immediately with the colour scale on packaging Refractometry • Technique – Clean the refractometer and calibrate – Open the lid and apply one drop of urine – Close the lid and evaluate the specific gravity Bacteriology • Technique – Dip urine into the bacterial culture (Uricult®) – Close the tube Cytology • Technique – – – – – – – – – – – –

Centrifugation of the urine sample (c. 10 min at 3,000 rpm) Decant the supernatant Plump up the sediment Transfer the sample onto a microscope slide Add a cover slide Perform a microscopic examination (crystals) Remove the cover slide Dry the sample Fixate and stain the sample Rinse the sample with water/distilled water Dry the sample in a tilted position Perform a microscopic examination (cytology)

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EXAMINATION METHODS

Faecal Sample Indication • Parasitological and bacteriological examination Coprological Examination: Flotation

Fig 2.110 Press the fecalyser into the faeces

Fig 2.111 Transfer the fecalyser into a container

Fig 2.112 Add flotation fluid

Fig 2.113 Twist the inset container several times

SAMPLE PROCESSING

Faecal Sample: Flotation and Bacteriological Examination

Fig 2.114 Add the flotation fluid (above meniscus)

Fig 2.115 Apply a cover slide

Fig 2.116 Transfer the cover slide to a microscope slide after 15 mins

Fig 2.117 Microscopic examination

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CARDIOLOGICAL EXAMINATION METHODS

55

Findings • Physiological Capillary refill time – < 2 sec Pulse – Regular, even, of medium size, strength, arterial filling and tension, no pulse deficits Hepatojugulary reflex – No evidence of jugular vein congestion/-dilation Thyroid – Not palpable Trachea – Unable to elicit a coughing reflex with moderate tracheal compression Cardiac apex beat – Apex beat on the left cranial thoracic wall – Hypokinetic: physiological with a broad thorax/obesity Liver/spleen – Caudal liver edges are hardly palpable Abdomen (fluid thrill) – No fluid pressure wave palpable • Pathological Capillary refill time – > 2 sec (reduced cardiac output/peripheral impairment of blood supply) Pulse: hyperkinetic – Pulsus celer (fast), altus (high amplitude) et durus (hard) (aortic insufficiency, anaemia, hyperthyroidism, fever, persistent ductus arteriosus) – Pulsus celer (fast) et parvus (small amplitude) (Hypovolaemia) Pulse: hypokinetic – Pulsus tardus (slow), parvus (small amplitude) et mollis (soft) (aortic stenosis, pulmonary stenosis, shock) – Pulsus alternans (variable strength) (heart failure)

SAMPLE PROCESSING

Coprological Examination Flotation • Technique – – – – – – – – –

Press the fecalyser into the faecal sample Transfer the fecalyser into its container Add the flotation fluid Twist the inset container several times for mixing Top up the flotation fluid with a pipette above the meniscus Apply a cover slide Wait c. 15 min Transfer the cover slide onto a microscope slide Perform a microscopic examination (oocyst)

Plain Sample Preparation • Technique – – – –

Apply a rice grain sized faecal sample onto a microscope slide Mix in two drops of saline Apply a cover slide Perform a microscopic examination (coccidia + oocyst)

Dispatch of the Sample • Technique – – – –

Bacteriology Protozoology (Giardia spp.) Digestive products Digestive enzymes

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3 Cardiological Examination Methods Case History Principal Symptoms • • • • • • • •

Performance insufficiency Respiratory distress Cough Syncope Nocturnal unrest Weight loss Paraparesis (especially cat) Cyanosis

Inspection Indication • Part of the general examination Method • Technique – Observation of the body position/stance and respiration at rest – Observation of the oral and preputial/vulval mucous membranes, neck including jugular veins, thorax and abdomen on the examination table (often in combination with palpation) • Evaluation criteria – Size, shape, symmetry, respiratory rhythm (inspiration / expiration), jugular venous pulse, mucous membrane colour

CARDIOLOGICAL EXAMINATION METHODS

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Findings • Physiological – Costoabdominal respiration/respiration rate 10–30/min – Mucous membrane colour: pink – No visible jugular venous pulse • Pathological Respiration – Abdominal respiration (thoracic disease) – Costal respiration (abdominal disease) – Bradypnoea (sedation, CNS disease) – Tachypnoea (agitation, pain, systemic disease) – Inspiratory dyspnoea (upper airway disease) – Expiratory dyspnoea (lower airway disease) – Orthopnoea (lower airway disease) – Open-mouth breathing (lower airway disease) – Cheyne-Stokes breathing (CNS/cardiac disease, endocrine disease) Mucous membrane colour – Pallor (circulatory collapse/shock, anaemia) – Cyanosis (peripheral) (generalised blue colour of the mucous membranes as a result of heart failure and reduced cardiac output) – Cyanosis (central) (blue colour of the mucous membranes in the caudal body parts (vagina/prepuce) as a result of congenital heart disease with right to left shunt (Tetralogy of Fallot, Eisenmenger’s syndrome – pulmonary hypertension with shunt reversal with persistent ductus arteriosus, ventricular septal-/atrial septal defect) – Cyanosis (paws/claws/pads of the hind limb) (aortic thromboembolism as a result of heart failure) Increased abdominal girth – Ascites/hepatomegaly (right-sided heart failure) State of nutrition – Cachexia (e.g., with left-sided heart failure) – Obesity (e.g., with right-sided heart failure) Congestion of jugular vein – Right-sided heart failure, pericardial effusion/cardiac tamponade – Jugular venous pulse – Tricuspid valve insufficiency, pulmonary valve stenosis, AVdissociation as a result of right atrial contraction with closed tricuspid valve

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EXAMINATION METHODS

Palpation Indication • Part of the general examination Palpation

Fig 3.1 Measure the capillary refill time

Fig 3.2 Compare the femoral arterial pulses

Fig 3.3 Hepatojugulary reflex

Fig 3.4 Palpate the thyroid

CARDIOLOGICAL EXAMINATION METHODS

Fig 3.5 Palpate the trachea

Fig 3.6 Palpate the cardiac apex beat

Fig 3.7 Palpate the liver and spleen

Fig 3.8 Fluid thrill

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EXAMINATION METHODS

Method • Technique Capillary refill time – Apply digital pressure to an area of unpigmented mucous membrane in the mouth – Let go and measure the time until the original mucous membrane colour has been reinstated Pulse – Feel the femoral arterial pulse wave with flatly placed fingertips of the index and middle finger – Palpate and compare both femoral arterial pulses with the heart rate via auscultation – Evaluate the frequency, regularity, evenness, quality (size and strength) and arterial filling/tension Hepatojugulary reflex – Lift the cranial abdomen while looking at both jugular veins – Evaluate jugular congestion, dilation and venous pulse Thyroid – Palpate and compare both sides of the ventral neck region with index/middle finger Trachea – Feel the trachea between your thumb and index/middle finger – Compress the trachea slightly Cardiac apex beat – Place the palms of your hands on both sides of the cranial thorax Liver/spleen – Feel the organ edges (possibly while the patient is standing) Abdomen (fluid thrill) – Tap the lateral abdominal wall with the fingers of one hand, while the other hand is flatly placed against the collateral side feeling a pressure wave (in case of abdominal effusion)

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55

Findings • Physiological Capillary refill time – < 2 sec Pulse – Regular, even, of medium size, strength, arterial filling and tension, no pulse deficits Hepatojugulary reflex – No evidence of jugular vein congestion/-dilation Thyroid – Not palpable Trachea – Unable to elicit a coughing reflex with moderate tracheal compression Cardiac apex beat – Apex beat on the left cranial thoracic wall – Hypokinetic: physiological with a broad thorax/obesity Liver/spleen – Caudal liver edges are hardly palpable Abdomen (fluid thrill) – No fluid pressure wave palpable • Pathological Capillary refill time – > 2 sec (reduced cardiac output/peripheral impairment of blood supply) Pulse: hyperkinetic – Pulsus celer (fast), altus (high amplitude) et durus (hard) (aortic insufficiency, anaemia, hyperthyroidism, fever, persistent ductus arteriosus) – Pulsus celer (fast) et parvus (small amplitude) (Hypovolaemia) Pulse: hypokinetic – Pulsus tardus (slow), parvus (small amplitude) et mollis (soft) (aortic stenosis, pulmonary stenosis, shock) – Pulsus alternans (variable strength) (heart failure)

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EXAMINATION METHODS

– Pulsus paradoxus (reduced strength in inspiration) (pericardial effusion/cardiac tamponade) – Pulse deficit (difference between the heart and pulse rate) (haemodynamically ineffective extrasystoles, absolute tachyarrhythmia) – Missing pulse with a physiological heart rate (vessel occluding disease process) Hepatojugulary reflex – Congestion/dilation of the jugular vein (right-sided heart failure) Thyroid – Goitre (hyperthyroidism, abscess, tumour) Trachea – Cough (tracheitis/tracheobronchitis) Cardiac apex beat – Hyperkinetic: hyperthyroidism, aortic insufficiency, anaemia – Hypokinetic: shock, pericardial effusion/cardiac tamponade, pulmonary emphysema, pneumothorax – Changed position (cardiomegaly) Liver/spleen – Increased liver size (e.g., right-sided heart failure, tumour) Abdomen (fluid thrill) – Positive (abdominal effusion)

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Auscultation Indication • Part of the general examination Auscultation

Fig 3.9 Auscultation with a stethoscope

Fig 3.10 Auscultation while occluding the nostrils

Fig 3.11 Puncta maxima of heart sounds (left): P = pulmonary valve; A = aortic valve; M = mitral valve

Fig 3.12 Puncta maxima of heart sounds (right): T = tricuspid valve

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EXAMINATION METHODS

Measuring the Heart Size

Fig 3.24 VHS method: measure the longitudinal axis

Fig 3.25 VHS method: measure the horizontal axis

Fig 3.26 ICR method: measure the horizontal axis

Fig 3.27 ICR method: measure the horizontal axis

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Method • Technique – Auscultation between the third and fifth intercostal space of the left, right and cranial thoracic wall – Auscultation while the patient is standing – Perform a comparing palpation of the femoral arterial pulse – Provide a calm environment, best done with closed eyes, consider occluding the nostrils momentarily – Consider distracting purring cats by having a water tap running • Heart sounds – Evaluate the number of sounds (usually two), heart rate, separation/division, regularity, evenness, quality (loud, quiet, drumming) and clicks • Heart murmurs Time of occurrence – Systole (holosystolic, mesosystolic, late systolic) – Diastole (early diastolic, mesodiastolic, presystolic) – Continuous (systolic/diastolic, machine-like) Volume – Grade 1 very quiet (audible only during apnoea) – Grade 2 quiet (audible after a brief period of time) – Grade 3 medium-loud (immediately audible) – Grade 4 loud – Grade 5 very loud (audible while the stethoscope is lifted off the thoracic wall) Puncta maxima – Pulmonary valve: left thoracic wall, third intercostal space below the costochondral junction – Aortic valve: left thoracic wall, fourth intercostal space above the costochondral junction – Mitral valve: left thoracic wall, fifth intercostal space at the costochondral junction – Tricuspid valve: right thoracic wall, fourth intercostal space at the costochondral junction

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EXAMINATION METHODS

Sound character – Crescendo (rising sound) – Decrescendo (subsiding sound) – Crescendo – decrescendo – Sound conduction – Extracardial (respiratory, peristaltic, pericardial or rubbing sounds) • Heart cycle Flow characteristics – Left heart: lung → pulmonary veins → atrium → mitral valve → ventricle → aortic valve → aorta → body – Right heart: body → V. cava → atrium → tricuspid valve → ventricle → pulmonary valve → pulmonary artery → lung Pulse – Haemodynamic pressure wave during systole Heart sounds – 1. Heart sound – closure of the mitral and tricuspid (atrioventricular) valves – 2. Heart sound – closure of the aortic and pulmonary (semilunar) valves – Systole – ventricular expulsion phase – Diastole – ventricular filling phase

CARDIOLOGICAL EXAMINATION METHODS

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Findings During Auscultation

ECG

physiological heart sounds split first heart sound

split second heart sound summation gallop

Fig 3.16 Conduction of heart sounds (left) mesosystolic click

Fig 3.18 Pathological heart sounds (ECG – physiological heart sounds – split first heart sound – split second heart soundsummation gallop – mesosystolic click)

Fig 3.17 Conduction of heart sounds (right)

Fig 3.19 (below) Heart murmurs (holosystolic band shaped – mesosystolic spindle shaped – early diastolic subsiding – continuous (machine sound) – AV-valve insufficiency – semilunar valve stenosis – persistent ductus arteriosus

holosystolic band shaped

AV-VALVE INSUFFIENCY

mesosystolic spindle shaped

SEMILUNAR VALVE STENOSIS

early diastolic subsiding continuous (machine sound)

SEMILUNAR VALVE INSUFFICIENCY

PERSISTENT DUCTUS ARTERIOSUS

CARDIOLOGICAL EXAMINATION METHODS

Fig 3.46 Pulmonary oedema (l)

Findings • Physiological – Nothing abnormal to detect (NAD) • Pathological Heart size Bilateral atrial enlargement – Chronic AV-valve insufficiency (mitral valve/tricuspid valve) – Ventricular septal defect (VSD) – Dilated cardiomyopathy (DCMP) Generalised cardiomegaly – Pericardial effusion/cardiac tamponade Right-sided cardiomegaly (RA + RV) – Cor pulmonale (as a result of respiratory disease)

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Fig 3.47 Pleural effusion (l)

– Pulmonary valve stenosis (PS) – Tricuspid valve insufficiency (TI) – Atrial septal defect (ASD) – Tetralogy of Fallot – Shunt-reversal (Eisenmenger Syndrome) – Persistent ductus arteriosus (PDA) – Atrial/ventricular septal defect (ASD/VSD) Left-sided cardiomegaly (LA + LV) – Cardiomyopathy – Mitral valve insufficiency (MI) – (Sub-)aortic stenosis and aortic insufficiency (SAS/AI) – Ventricular septal defect (VSD) – Persistent ductus arteriosus (PDA)

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X-Ray Study Indication • Heart/respiratory disease X-Ray Study

Fig 3.20 Patient positioning (lateral view)

Fig 3.21 Patient positioning (dorsoventral view)

Fig 3.22 Radiological anatomy (lateral projection)

Fig 3.23 Radiological anatomy (dorsoventral projection)

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EXAMINATION METHODS

Measuring the Heart Size

Fig 3.24 VHS method: measure the longitudinal axis

Fig 3.25 VHS method: measure the horizontal axis

Fig 3.26 ICR method: measure the horizontal axis

Fig 3.27 ICR method: measure the horizontal axis

CARDIOLOGICAL EXAMINATION METHODS

Method • Technique – Perform risk/benefit assessment (if the patient is dyspnoeic) – Plan and agree the proposed procedure with colleagues and owners – Fully inform the owner (consider questions about pregnancy and age range) – Handle the patient calmly and in a coordinated manner – Possible distraction – Projection of two views if at all possible – Thoracic radiographs generally in maximum inspiration (check X-ray for elevation of diaphragm) – Left and right lateral views – Second X-ray view usually in sternal/prone position (dorsoventral) – Opposing ribs should overlap perfectly • Radiological anatomy – Right atrium (RA) – Left atrium (LA) – Right ventricle (RV) – Left ventricle (LV) – Pulmonary trunk/truncus pulmonalis (TP) – Left pulmonary artery (LPA) – Right pulmonary artery (RPA) – Aorta (Ao) – Vena cava (Vc)

– Mediastinum – Trachea

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(M) (T)

• Measure the heart size – VHS-Method (vertebral heart size) – Measure the longitudinal axis (bifurcation to apex), compare this with the sum of the vertebral lengths from T4 – Measure the horizontal axis (maximum cardiac width 90° to the longitudinal axis) – Compare this with the sum of the vertebral lengths from T4 – VHS = vertebral lengths of the longitudinal axis + vertebral lengths of the horizontal axis (normal range in the dog: 8.5–10.5) – ICR method (intercostal room) – Measure the longitudinal axis of the thoracic cavity (thoracic vertebraebifurcation-sternum), normal value in the dog: cardiac height should be two-thirds of the thoracic cavity – Measure the horizontal axis (maximum cardiac width) by counting the intercostal spaces (normal range in the dog: heart width 2.5–3.5 intercostal spaces or 50–60 per cent of the thoracic diameter)

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EXAMINATION METHODS

X-Ray Findings

Fig 3.28 Physiological heart size (lateral)

Fig 3.29 Physiological heart size (dorsoventral)

Fig 3.30 Bilateral atrial enlargement (l)

Fig 3.31 Bilateral atrial enlargement (d/v)

Fig 3.32 Generalised cardiomegaly (l)

Fig 3.33 Generalised cardiomegaly (d/v)

CARDIOLOGICAL EXAMINATION METHODS

Fig 3.34 Right-sided cardiomegaly (RA+RV) (l)

Fig 3.35 Right-sided cardiomegaly (RA+RV) (d/v)

Fig 3.36 Left-sided cardiomegaly (LA+LV) (l)

Fig 3.37 Left-sided cardiomegaly (LA+LV) (d/v)

Fig 3.38 Left-sided atrial enlargement (LA) (l)

Fig 3.39 Left-sided atrial enlargement (LA) (d/v)

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EXAMINATION METHODS

Fig 3.62 Mean electrical axis, MEA (1), in illustration: sum

Fig 3.63 Mean electrical axis (2)

Fig 3.64 Physiological mean electrical axis (dog)

Fig 3.65 Physiological mean electrical axis (cat)

CARDIOLOGICAL EXAMINATION METHODS

Fig 3.46 Pulmonary oedema (l)

Findings • Physiological – Nothing abnormal to detect (NAD) • Pathological Heart size Bilateral atrial enlargement – Chronic AV-valve insufficiency (mitral valve/tricuspid valve) – Ventricular septal defect (VSD) – Dilated cardiomyopathy (DCMP) Generalised cardiomegaly – Pericardial effusion/cardiac tamponade Right-sided cardiomegaly (RA + RV) – Cor pulmonale (as a result of respiratory disease)

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Fig 3.47 Pleural effusion (l)

– Pulmonary valve stenosis (PS) – Tricuspid valve insufficiency (TI) – Atrial septal defect (ASD) – Tetralogy of Fallot – Shunt-reversal (Eisenmenger Syndrome) – Persistent ductus arteriosus (PDA) – Atrial/ventricular septal defect (ASD/VSD) Left-sided cardiomegaly (LA + LV) – Cardiomyopathy – Mitral valve insufficiency (MI) – (Sub-)aortic stenosis and aortic insufficiency (SAS/AI) – Ventricular septal defect (VSD) – Persistent ductus arteriosus (PDA)

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EXAMINATION METHODS

• ECG measures – Heart rate/min at 25mm/sec – Number of QRS-complexes in 6 sec (15cm) × 10 at 50mm/sec – Number of QRS-complexes in 6 sec (30cm) × 10 – Amplitudes (lead II), P, Q, R, S, T at 1cm = 1mV: 1mm = 0.1mV – Time periods (lead II) – P, PQ, QRS, QT, RR – At 25mm/sec: 1mm = 0.04 sec – At 50mm/sec: 1mm = 0.02 sec – Mean electrical axis (vector-method) 1. Measure and add up the net-QRS-amplitudes of leads I and aVF (or leads I and III). Example: Lead I: Q = –0.3mV Lead aVF: Q = –0.4mV R = +0.9mV R = +1.5mV + 0.6 +1.1 2. Record the values in the appropriate axis 3. Plot the intersection of the vertical and horizontal lines through these values 4. Mean electrical heart axis = connecting line between the graph origin and the intersection found in step 3 • Evaluation criteria – Heart rhythm – Heart rate – Amplitudes – Time periods – Mean electrical axis

CARDIOLOGICAL EXAMINATION METHODS

Electrocardiography (ECG) Indication • Cardiac arrhythmias • Anaesthetic/intensive care monitoring ECG

Fig 3.48 Limb leads

Fig 3.49 Chest leads

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EXAMINATION METHODS

Fig 3.50 Select the recording speed

Fig 3.51 Select the recording amplitude

Fig 3.52 Select the leads (1–6)

Fig 3.53 Press start

Fig 3.54 Calibration 1 mV

Fig 3.55 Switch recording lead

CARDIOLOGICAL EXAMINATION METHODS

Fig 3.56 ECG readings (50mm/sec and 1cm = 1mV)

Fig 3.58 Amplitude formation of a normal P-QRS-T complex

Fig 3.60 Time/interval readings

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Fig 3.57 ECG readings (25mm/sec and 1cm = 1mV) Dog (mV)

Cat (mV)

P

< 0,4

< 0,2

Q

< 0,5

< 0,5

R

< 2,5 (< 25 kg BW) < 3,0 (> 25kg BW)

< 0,9

S

< 0,35 (< 25% vonR)

Fig 3.59 Amplitude readings (normal values) Dog

Cat

(sec)

(sec)

P

< 0,04

< 0,04

PQ

< 0,13

< 0,09

QRS

< 0,05

< 0,04

QT

< 0,25

< 0,18

Fig 3.61 Time/interval readings (normal values)

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EXAMINATION METHODS

Fig 3.72 Supraventricular tachycardia

Fig 3.73 Atrial flutter/fibrillation

Fig 3.74 Ventricular ectopic complex

Fig 3.75 Ventricular tachycardia

Fig 3.76 Ventricular fibrillation

Fig 3.77 First degree AV-block

CARDIOLOGICAL EXAMINATION METHODS

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Method • Technique – Placement of the electrodes – Patient in lateral recumbency (standing if in respiratory distress) – Stretch the crocodile clips (they are quite painful, consider filing the teeth down!) – Place the crocodile clip electrodes onto a skin fold – Moisten the skin/electrodes with spirit/electrode gel) – Position of electrodes (standard leads) – Red (right forelimb proximal of the olecranon) – Yellow (left forelimb proximal of the olecranon) – Green (left hind limb knee fold) – Black (usually right hind limb knee fold) – Position of electrodes (chest leads) – White rV2 (CV5RL): right chest wall, fifth intercostal space, parasternal – White V2 (CV6LL): left chest wall, sixth intercostal space, parasternal – White V4 (CV6LU): left chest wall, sixth costochondral junction – White V10: between shoulder blades at level with Th6–7 • Device operation – Example type Multiscriptor EK 33® Hellige[HJ1] – Select the paper speed 25mm/sec, 50mm/sec – Select the recording amplitude, usually 1cm/mV (1⁄4cm/mV, 1 ⁄2cm/mV, 2cm/mV) – Select the leads (program 1–6) – Program 1 (leads I, II, III) – Program 2 (leads aVR, aVL, aVF) – Program 3 (leads V1, V2, V3) – Program 4 (leads V4, V5, V6) – Press the start button – Calibration button (calibration 1cm) – Switch settings while writing. Fine tune the amplitude with filter button. Order of studies: – 1. Calibration – 2. Program 1 ( I, II, III) at 25mm/sec, 1cm/mV – 3. Program 1 (I, II, III) at 50mm/sec, 1cm/mV – 4. Program 2 (I, II, III) at 50mm/sec, 1cm/mV

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EXAMINATION METHODS

• ECG measures – Heart rate/min at 25mm/sec – Number of QRS-complexes in 6 sec (15cm) × 10 at 50mm/sec – Number of QRS-complexes in 6 sec (30cm) × 10 – Amplitudes (lead II), P, Q, R, S, T at 1cm = 1mV: 1mm = 0.1mV – Time periods (lead II) – P, PQ, QRS, QT, RR – At 25mm/sec: 1mm = 0.04 sec – At 50mm/sec: 1mm = 0.02 sec – Mean electrical axis (vector-method) 1. Measure and add up the net-QRS-amplitudes of leads I and aVF (or leads I and III). Example: Lead I: Q = –0.3mV Lead aVF: Q = –0.4mV R = +0.9mV R = +1.5mV + 0.6 +1.1 2. Record the values in the appropriate axis 3. Plot the intersection of the vertical and horizontal lines through these values 4. Mean electrical heart axis = connecting line between the graph origin and the intersection found in step 3 • Evaluation criteria – Heart rhythm – Heart rate – Amplitudes – Time periods – Mean electrical axis

CARDIOLOGICAL EXAMINATION METHODS

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ECG – Findings

Fig 3.66 Sinus tachycardia (normal ECG)

Fig 3.67 Sinus bradycardia (normal ECG)

Fig 3.68 SA-Block/sinus arrest (normal ECG)

Fig 3.69 Sick-sinus-syndrome (normal ECG)

Fig 3.70 Atrial standstill (normal ECG)

Fig 3.71 Supraventricular premature complex (normal ECG)

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EXAMINATION METHODS

Fig 3.72 Supraventricular tachycardia

Fig 3.73 Atrial flutter/fibrillation

Fig 3.74 Ventricular ectopic complex

Fig 3.75 Ventricular tachycardia

Fig 3.76 Ventricular fibrillation

Fig 3.77 First degree AV-block

CARDIOLOGICAL EXAMINATION METHODS

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Fig 3.78 Second degree AV-block (Mobitz Type 1)

Fig 3.79 Second degree AV-block (Mobitz Type 2)

Fig 3.80 Third degree AV-block

Fig 3.81 Asystole

Fig 3.82 Electrical alternans

Fig 3.83 Low voltage

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EXAMINATION METHODS

Fig 3.84 Right atrial enlargement (RA)

Fig 3.85 Left atrial enlargement (LA)

Fig 3.86 Right ventricular enlargement (RV)

Fig 3.87 Left ventricular enlargement (LV)

Fig 3.88 Right axis deviation (dog)

CARDIOLOGICAL EXAMINATION METHODS

Pathological Findings • Sinus Tachycardia ECG – findings – Heart rate > 180/min (dog), > 220/min (puppy/cat) Causes – Pain – Fever – Anaemia – Hyperthyroidism – Excitement/sympathetic tone – Heart failure • Sinus bradycardia ECG – findings – Heart rate < 60/min (dog), < 100/min (cat) Causes – Parasympathetic tone/vagal tone – Carotid sinus irritation (collar) – Cerebral pressure – Hypothyroidism – Medication/anaesthetic agents (digoxin, xylazine) – Heart failure • SA-block/sinus arrest ECG – findings – Rest between P-QRS-T-complexes (often longer than two normal RR-intervals) Causes – Parasympathetic tone/vagal tone – Sinus node dysfunction • Sick-sinus-syndrome ECG – findings – Alternating sinus bradycardia/sinus arrest with paroxysmal supraventricular extrasystole/supraventricular tachycardia

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Causes – Sinus node dysfunction – Genetic causes (Miniature Schnauzer) • Atrial standstill ECG – findings – Reduced heart rate (escape rhythm) – Missing P-wave – Prolonged QRS-Interval – Prolonged QT-Interval – Reduced R-wave voltage – Tall and spiked T-waves Causes – Hyperkalaemia • Supraventricular premature complex ECG – findings – Premature P-wave – Slightly distorted P-waves Causes – Vegetative dystonia – Medication (e.g., digoxin, anaesthetic agents) – AV-valve insufficiency • Atrial flutters/fibrillation ECG – findings – Increased heart rate – Irregular rhythm – Missing P-waves Causes – Atrial myocardial disease (especially giant breeds) – Drugs (e.g. digoxin) • Ventricular ectopic complex ECG – findings – Premature, deformed QRS-complex – P-waves unconnected to QRS-complex – Complete compensatory pause (ventricular escape complex) – Bigeminy: every second complex is premature – Trigeminy: every third complex is premature

CARDIOLOGICAL EXAMINATION METHODS

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Causes – Electrolyte imbalances – Medications (e.g., digoxin, xylazine, barbiturates, antiarrhythmic drugs) – Heart failure – Metabolic acidosis – Septicaemia/endotoxaemia – Hypoxia • Ventricular tachycardia ECG – findings – Ventricular premature complexes in rapid succession (three or more) – Distorted QRS-complexes Causes – Electrolyte imbalances – Medications(e.g., digoxin, phenobarbitone, antiarrhythmic drugs) – Heart failure – Metabolic acidosis – Septicaemia/endotoxaemia – Hypoxia • Ventricular fibrillation ECG – findings – Undulations (fine/coarse) of the baseline – QRS-complexes present? Causes – Electrolyte imbalances – Medications (e.g., digoxin, phenobarbitone, antiarrhythmic drugs) – Heart failure/hypoxia – Metabolic acidosis – Septicaemia/endotoxaemia • First grade AV-block ECG – findings – Prolonged PQ-interval > 0.13 sec (dog), > 0.10 sec (cat)

CARDIOLOGICAL EXAMINATION METHODS

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Causes – Electrolyte imbalances – Medications (e.g., digoxin, xylazine, barbiturates, antiarrhythmic drugs) – Heart failure – Metabolic acidosis – Septicaemia/endotoxaemia – Hypoxia • Ventricular tachycardia ECG – findings – Ventricular premature complexes in rapid succession (three or more) – Distorted QRS-complexes Causes – Electrolyte imbalances – Medications(e.g., digoxin, phenobarbitone, antiarrhythmic drugs) – Heart failure – Metabolic acidosis – Septicaemia/endotoxaemia – Hypoxia • Ventricular fibrillation ECG – findings – Undulations (fine/coarse) of the baseline – QRS-complexes present? Causes – Electrolyte imbalances – Medications (e.g., digoxin, phenobarbitone, antiarrhythmic drugs) – Heart failure/hypoxia – Metabolic acidosis – Septicaemia/endotoxaemia • First grade AV-block ECG – findings – Prolonged PQ-interval > 0.13 sec (dog), > 0.10 sec (cat)

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Causes – Parasympathetic tone/vagal tone – Medications (e.g., digoxin, xylazine) – Hyperkalaemia, hypocalcaemia – AV-node-degeneration – Cardiomyopathy/myocarditis – Aortic stenosis/ventricular septal defect • Asystole ECG – findings – Baseline without any pulses (no measurable cardiac activity) Causes – Terminal heart disease – Hyperkalaemia – Metabolic acidosis – Third degree AV-block without escape rhythms • Electrical alternans ECG – findings – Alternating variation in QRS amplitude Causes – Heart failure – Pericardial effusion/cardiac tamponade • Low voltage ECG – findings – Decreased voltage of R-waves (< 1mV) Causes – Obesity – Pericardial effusion/cardiac tamponade • Right atrial (RA) enlargement ECG – findings – Tall and spiky P-wave (P-pulmonale) amplitude: > 0.4mV (dog), > 0.2mV (cat) • Left atrial (LA) enlargement ECG – findings – Prolonged and broad (sometimes notched) P-Wave (P-mitrale) – Interval: > 0.04mV (dog/cat)

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EXAMINATION METHODS

• Right ventricular (RV) enlargement ECG – findings – S-waves present in leads I, II, III – Right axis deviation – Axis: 100° to –75° (dog), 160° to –75° (cat) – Deep S-waves in V3 • Left ventricular (LV) enlargement ECG – findings – Possibly tall R-waves amplitude: > 3.0 mV (dog), > 0.9 mV (cat) – Possibly prolonged QRS-complex: > 0.05 sec (dog) • Right axis deviation ECG – findings – Shift of the mean electrical axis to right (right axis). Axis: 100° to –75° (dog), 160° to –75° (cat) Causes – Right ventricular enlargement • Hyperkalaemia ECG – findings – Atrial standstill – Progressive bradycardia – Flat or missing P-wave – Prolonged PQ-interval – Prolonged QRS-interval – Shortened QT-interval ST-depression – Increased amplitude of T-wave, narrow and spiked • Hypokalaemia ECG – findings – Tachycardia/tachyarrhythmia) – Prolonged QT-interval – ST-depression – Decreased and prolonged amplitude of T- wave, flat and broad • Hypercalcaemia ECG – findings – Tachycardia (tachyarrhythmia) – Shortened QT-interval

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CARDIOLOGICAL EXAMINATION METHODS

• Hypocalcaemia ECG – findings – Tachycardia (tachyarrhythmia) – Prolonged QT-interval • Digoxin ECG – findings – AV-block – Sinus bradycardia/sinus standstill – Ventricular ectopic complexes/ventricular tachycardia – Supraventricular premature complexes/supraventricular tachycardia/atrial fibrillation (in presence of bradycardia) • Xylazine ECG – findings – Sinus bradycardia/sinus standstill – AV-block – Ventricular ectopic complexes • Lidocaine ECG – findings – Sinus bradycardia/sinus standstill – AV-block Complications • Muscle tremors • Electrical interactions • Painful crocodile forceps

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87

88

EXAMINATION METHODS

Ultrasound Examination Indication • Suspected acquired or congenital heart diseases • Therapy monitoring Positioning of the Patient

Fig 3.89 Examination in right lateral recumbency

Fig 3.90 Examination in left lateral recumbency

Fig 3.91 Subcostal examination in lateral recumbency

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CARDIOLOGICAL EXAMINATION METHODS

Fig 3.92 Right lateral recumbency parasternal, third–fourth intercostal space position of transducer: upright

Fig 3.93 Longitudinal axis (four-chamber view) B-Mode

Dog

Cat

4–12

2,5–5

LVDD (mm)

21–61

11–16

LVWD (mm)

3–12

2,5–5

IVSS (mm)

7–20

5–9

LVDS (mm)

10–45

6–10

LVWS (mm)

4,5–19

4–9

FS (%)

30–40

29–55

DIASTOLE

SYSTOLE

IVSD (mm)

LV

Fig 3.94 Longitudinal axis M-Mode

Fig 3.95 Measurements longitudinal axis M-/B-Mode

MK E-Shaft

A-Shaft

ECG

Fig 3.96 Longitudinal axis (mitral valve) B-Mode

89

Fig 3.97 Longitudinal axis M-Mode

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90

EXAMINATION METHODS

Dog

Cat

DEAMP (mm)

17–18

EPSS (mm)

3–4

2–6

EF-Slope (mm/s)

150–155

55–87

Fig 3.98 Measurements longitudinal axis M-Mode

Fig 3.99 Right lateral recumbency parasternal, third–fourth intercostal space, position of transducer: tilt towards cranial

Fig 3.100 Longitudinal axis (LV-outflow tract) B-Mode

Fig 3.101 Longitudinal axis M-Mode

Dog

Cat

LA (mm)

12–33

8–15

Ao (mm)

10–30

7–12

LA:Ao

30kg – Young – Healthy – Good tempered – DEA-1.1/1.2/7 neg – Brucella-, ehrlichia-, leishmania-, babesia-, dirofilaria- neg. – No self-transfusion (as recipient)

TRANSFUSION

469

• Transfusion volume – Volume (ml) = 85 (dog) or 60 (cat) × BW (kg) × [(Desired PCV – Actual PCV)/Donor PCV] – dog = 10–20ml/kg BW (donor) (usually 450–500ml/dog > 25kg broadly correct (BW) • Anticoagulant – If full blood collection < 450ml remove a proportional and sterile amount of CPDA-1 (anticoagulant solution) out of the transfusion bag – 70ml CPDA-1/500ml full blood • Blood collection – Intravenous infusion access (peripheral venous catheter) (donor) – Hold the donor in lateral recumbency with an extended neck (possibly slight sedation) – Clip the fur – Disinfect the skin – Raise the vein – Indirect puncture of the external jugular vein 1. Elevate a skin fold 2. Puncture the skin 3. Puncture the vein – Fixate the puncture needle during the blood collection – At the end of the collection remove the puncture needle and apply pressure over the puncture site with a gauze swab (compression time about 2–3 min) – Clamp, knot and cut the collection line tubing • Infusion – Full electrolyte solution (twice the amount of blood lost) (donor) • Cross matching – No adverse reactions to be expected in first time recipients of unrelated donors Blood typing (DEA-1.1) (Rapid Vet-H® canine test cards) – Collect at least 0.5ml EDTA blood – Label the test card – Apply one drop of diluent solution into each test well – Add one drop of positive control solution into the DEA-1.1 positive control well – Mix the solution with the spatula contained in test kit

470

TREATMENT METHODS

– Add 1 drop of negative control solution into DEA-1.1 negative control well – Mix the solution with the spatula contained in test kit – Swill the EDTA blood sample – Pipette and add one drop of the blood sample into the patient test well – Mix the blood sample with a new spatula included in the test kit – Swill the test card horizontally (about 2 min) – Position the test card in an angle of 30–45° – Read the test results, example: – 1. Positive control (agglutination) – 2. Negative control (no agglutination) – 3. Patient (agglutination = DEA 1.1 positive): i.e. suitable as recipient of DEA-1.1-positive and DEA-1.1-negative blood and no suitability as blood donor for DEA-1.1-negative recipients Cross matching test (major test/minor test) – Take a blood sample and fill an EDTA and serum tube each from both the recipient and donor – Centrifuge the serum tubes (donor and recipient serum) – Wash the erythrocytes of the EDTA tubes (donor and recipient erythrocytes) (centrifuge, decant the plasma, fill the tubes with saline, centrifuge, decant the plasma) – Make a 4 per cent cell suspension (donor and recipient tube) (0.2ml washed erythrocytes + 4.8ml saline) – Label the test tubes Major test – Two drops (0.1ml) donor cell suspension + 2 drops (0.1ml) recipient serum Minor Test – Two drops (0.1ml) donor serum + two drops (0.1ml) recipient cell suspension Donor control test – 2 drops (0.1ml) donor cell suspension + two drops (0.1ml) donor serum Recipient control test – Two drops (0.1ml) recipient cell suspension + two drops (0.1ml) recipient serum

FLUSHES

541

Method • Preparation – Intravenous catheter – Infusion therapy according to the potassium level (usually physiological saline) – Possibly sedation (usually avoidance of ketamine) – Dorsal position or lateral recumbency – Possibly cystocentesis for pressure release – Extrusion of the penis – Apply sterile lubricant/physiological saline onto the tip of the urinary catheter • Technique – Fixate the penis on the penis bone – Insert the urinary catheter into the urethra until the obstruction is reached (uroliths) – Occlude the distal urethra via rectal digital pressure – Flush with physiolical saline (10ml syringe) for urethral dilation – Release the digital pressure – Flush while occluding the urethral opening Complications • Perforation of the urethra or urinary bladder • Infection • Hyperkalaemia/hypokalaemia

472

TREATMENT METHODS

Full Blood Transfusion in the cat

Fig 17.9 Draw up 7ml CPDA-1 in a syringe

Fig 17.10 Attach a butterfly catheter

Fig 17.11 Open the three-way tap

Fig 17.12 Puncture the external jugular vein

Fig 17.13 Blood collections (50ml) while slightly aspirating

Fig 17.14 Close the three-way tap

TRANSFUSION

Fig 17.15 Removal of the puncture needle

Fig 17.16 Transfer of blood into the transfusion bag

Fig 17.17 Clamp/cut off the collection line

Fig 17.18 Attach the transfusion line (including filter)

Fig 17.19 Attach transfusion line to intravenous catheter

Fig 17.20 Blood typing (A, B, AB)

473

474

TREATMENT METHODS

• System – Transfusion Set • Suitability as donor – > 4.5kg – Young – Healthy – Good tempered – Compatible blood type: blood type A to blood type A and blood type AB, blood type B to blood type B – FeLV-, FIV-, FIP- and hemobartonella-neg – No previous transfusion (as recipient) • Transfusion volume – ml required to raise haematocrit by 1 per cent (recipient) = 2.2ml full blood × kg BW – Desired haematocrit change (recipient) – Haematocrit (donor) • Transfusion volume – Cat = 10ml/kg BW(usually 50ml/cat > 5 kg BW) (donor) • Anticoagulant – 7ml CPDA-1/50ml full blood – Remove the three-way tap from the syringe – Attach the needle to the syringe – Draw up 7ml CPDA-1 into the syringe – Remove the needle and attach the three-way tap • Blood collection – Hold the donor in sternal/prone position with an extended neck (donor) (possibly slight sedation) – Clip the fur – Disinfect the skin – Raise the vein – Direct puncture of the external jugular vein with a butterfly catheter – Manually fixate the butterfly during the blood collection – Collect 50ml of blood while slightly aspirating with a syringe – Close the three-way tap at the end of the blood collection – Remove the puncture needle while compressing the puncture site with a gauze swab (compression time about 2–3 min) – Remove the collection line from the three-way tap – Swill the syringe (mix the blood/anticoagulant)

546

TREATMENT METHODS

Corrective Dressing

Fig 23.10 Unilateral corrective dressing (step 1)

Fig 23.11 Unilateral corrective dressing (step 2)

Fig 23.12 Bilateral corrective dressing (step 1)

Fig 23.13 Bilateral corrective dressing (step 2)

Method • Technique Unilateral – Place a gauze roll to the inside of the pinna – Apply an adhesive ear dressing Bilateral – Place two layers of adhesive dressing against each other to the inside and outside of each ear – Apply an adhesive ear dressing for each ear Complications • Dressing might slip

476

TREATMENT METHODS

– Make a 4 per cent cell suspension (donor and recipient tube) (0.2ml washed erythrocytes + 4.8ml saline) – Label the test tubes Major test – Two drops (0.1ml) donor cell suspension + two drops (0.1ml) recipient serum Minor test – Two drops (0.1ml) donor serum + two drops (0.1ml) recipient cell suspension Donor control test – Two drops (0.1ml) donor cell suspension + two drops (0.1ml) donor serum Recipient control test – Two drops (0.1ml) recipient cell suspension + two drops (0.1ml) recipient serum – Incubate the test tubes for 15 mins at room temperature (ideally 37°C, 25°C and 4°C) – Centrifuge the test tubes at 1,000 RPM for about 1 min – Read the test results 1. Donor control (no agglutination) 2. Recipient control (no agglutination) 3. Major test (agglutination = incompatible) 4. Minor test (agglutination = partially incompatible) (transfusion possibly based on clinical judgement in the absence of an alternative donor) • Transfusion – Attach the transfusion line including a micropore filter (recipient) to the transfusion bag and intravenous catheter – Initial transfusion rate 0.25ml/kg/h for about 15 min, then 10ml/kg/h (max. 4ml/kg/h in patients with cardiac insufficiency) Complications • Acute haemolysis – With blood group A donor and blood group B donor – Principal symptoms: haemoglobinaemia/-uria, excitation, tachycardia, renal failure, anaphylaxis, urticaria – Therapy: stop the transfusion, give glucocorticoids, commence infusion of a full electrolyte solution

TRANSFUSION

• Anaphylaxis – Membrane bound antigen incompatibilities, anticoagulant incompatibilities – Principal symptoms: urticaria, fever, shock – Therapy: stop the transfusion, give adrenaline, glucocorticoids, infusion (full electrolyte solution) • Volume overload – Principal symptoms: cough, tachypnoea, vomitus, pulmonary oedema – Therapy: stop the transfusion, commence diuresis

Preparation of Preserved Blood Units Indication • Erythrocyte concentrate (anaemia) – Plasma (plasmatic coagulopathies, acute pancreatitis) Plasma Production

Fig 17.21 Multibag system (clamping of the lines)

Fig 17.22 Transfusion bag (attach to transfer bag)

477

478

TREATMENT METHODS

Fig 17.23 Fridge storage for 8–12 hours

• System – Multibag system – Transfer bag • Preparation Multibag system – Clamp (mosquito forceps), cut and remove the blood collection line (from the syringe or puncture needle to the transfusion bag) – Clamp (mosquito forceps) the transfer line (from the transfusion to the transfer bag) Transfusion bag system – Clamp (mosquito forceps), cut and remove the blood collection line (from the puncture needle to the transfusion bag) – Connect to the transfer bag – Clamp(mosquito forceps)

Fig 17.24 Plasma transfer

the transfer line (from the transfusion bag to the transfer bag) • Technique – Store in a fridge inside a large book to promote sedimentation (8–12 hours) – Open the mosquito forceps – Close the book under gentle pressure (transfer about 80 per cent of the plasma into the transfer bag) – Clamp and seal each side of the transfer line • Storage – Plasma (freezer at –30°C keeps up to 12 months) – Erythrocyte concentrate (immediate transfusion or preparation with ADSOL preservative solution and storage up to one month at 4°C)

BANDAGES

551

Bandage for the Forelimb Indication • Wound dressing • Protective dressing

Fig 23.23 Elastic gauze dressing (including elbow/carpal joint)

including carpal joint

Fig 23.22 Cotton wool dressing (including elbow/carpal joint)

including elbow joint

including carpal joint

including elbow joint

Fig 23.21 Padding of the toes with cotton wool

including carpal joint

including elbow joint

Bandage for the Forelimb

Fig 23.24 Adhesive tape dressing (including elbow/carpal joint)

480

TREATMENT METHODS

Fig 17.29 Close the three-way tap

Fig 17.30 Remove the butterfly catheter and apply compression

Fig 17.31 Transfer into the transfusion bag

Fig 17.32 Clamping/cutting of the collection line

Fig 17.33 Attach the transfusion line (including filter)

Fig 17.34 Connect the transfusion line to the patient

552

TREATMENT METHODS

Fig 23.25 Forelimb/shoulder bandage

Method • Technique – Treat the wound – Cover the wound (gauze swab)

Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the carpal/elbow joint

Padding of the toes with cotton wool – Apply four cotton wool strips between the toes Cotton wool dressing – Single/double pattern around the sole of the foot – Parallel pattern (overlay of the cotton wool strips by about 50 per cent) from the paw to proximal of the carpal joint/elbow joint

Adhesive tape dressing – Protection of the sole of the foot (four vertical strips and one transverse strip) – Fixate the edges of the gauze dressing to the fur Complications • • • •

Dressing might slip off Pressure necrosis Putrefaction Unaccepting/panic (especially cats)

18 Inhalation Oxygen Supplementation Indication • Inhalation of oxygen and inhalation anaesthetics • Inhalation of medicines (antibiotics, antimycotics, cortisone preparations et al) Oxygen Supplementation

Fig 18.1 Pressure flow of oxygen through water

Fig 18.2 Modified Elizabethan collar

Fig 18.3 Nasal cannula

Fig 18.4 Nasal probe

INHALATION

483

Method • Technique Oxygen cage/tent – Commercial systems, e.g., Shor-Line®, neonatal incubators (human medicine) – Requires oxygen humidification via pressure feeding through saline – Oxygen flow rate 2–4 l/min. Modified Elizabethan collar – Cover the cone to about 90 per cent with cling film and supply oxygen through the attachment at the collar – Oxygen flow rate 4–6–8 l/min. Nasal cannula – Commercial systems from humane medicine are suitable for large dogs – Fixation on the skin via skin sutures/superglue or over the bridge of the nose with adhesive tape – Requires oxygen humidification via pressure feeding through saline – Elizabethan collar essential – Oxygen flow rate 4–6 l/min. Nasal probe/tube – Human neonatal feeding tubes (4–8FR) – Intranasal application of lidocaine 2 per cent solution – Raise the head (1–2 min) – Moisturise the tube with lubricant and lidocaine – Insert the tube into the ventral nasal meatus (up to about fourth premolar) – Fixate the tube with skin sutures/superglue lateral to the nostril and forehead – Requires oxygen humidification via pressure feeding through saline – Elizabethan collar essential – Oxygen flow rate 4–8 l/min. Complications • Dehydration/irritation of the airways • Epistaxis

484

TREATMENT METHODS

Endotracheal Intubation Indication • Oxygen supplementation/inhalation anaesthesia • Ventilation Endotracheal Intubation

Fig 18.5 Pull out the tongue

Fig 18.6 Laryngoscopy

Fig 18.7 Endotracheal insertion of the endotracheal (ET) tube

Fig 18.8 Insert a mouth wedge

INHALATION

485

Fig 18.9 Check the correct position of the ET tube via auscultation

Fig 18.10 Pull the tongue out to the side

Fig 18.11 Tie and fixate the ET tube

Fig 18.12 Cuff the ET tube very gently

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486

TREATMENT METHODS

Method • Preparation – Sedation – Sternal position/lateral recumbency/dorsal position – Choice of ET tube: as big as possible, easy to insert, measure the ET tube length on the patient – ET tube preparation: fixate the ties, check the patency of the ET tube, check the cuff, moisten the ET tube with water – Topical anaesthesia of the larynx (Lidocaine 2 per cent spray) especially in cats • Technique – Hold the patient with the neck extended, pull out the tongue with a gauze swab – Perform laryngoscopy and press down the tongue (without touching the glottis) – Gently insert the ET tube (possibly including a guidance rod) over the laryngoscope (during inspiration) – Place the mouth wedge and pull the tongue out to the side – Check the correct position of the ET tube (audible breathing sounds, palpable breath at the tube outlet) – Fixate the ET tube – Dog (mandibular, then maxillary loop tie) – Cat (mandibular loop tie, then loop tie behind the ears) – Slowly and gently cuff the ET tube Complications • Laryngospasm • Tracheal rupture • Unilateral lung ventilation

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558

TREATMENT METHODS

Elastic Bandage Indication • Support Dressing Elastic Bandage

Fig 23.38 Padding of the toes with cotton wool/cotton wool dressing

Fig 23.39 Elastic dressing

Fig 23.40 Elastic gauze dressing

Fig 23.41 Adhesive tape dressing

488

TREATMENT METHODS

Fig 18.19 Continued insertion of the ET tube

Method • Preparation – Sedation – Dorsal position/lateral recumbency – Clip the fur, disinfect the skin – Topical anaesthesia of the larynx (Lidocaine 2 per cent spray) especially in cats – System: central venous catheter set • Technique – Transcutaneous tracheal puncture with a cannula (second–fourth tracheal ring) (Seldinger technique) – Insert the Seldinger guide wire (from the CVC set) through the cannula into the tracheal lumen – Advance the guide wire towards rostral/cranial, until it becomes visible in the oral cavity – Endotracheal insertion of the ET tube over the guide wire – Remove the guide wire – Advance the ET tube Complications • Glottal oedema • Subcutaneous emphysema • Infection

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INHALATION

Tracheotomy Indication • Tracheal obstruction (foreign body, tumour, glottal oedema, laryngeal trauma) Tracheotomy

Fig 18.20 Position for tracheotomy

Fig 18.21 Skin incision

Fig 18.22 View after skin incision

Fig 18.23 Blunt dissection of the sternohyoid muscle

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489

490

TREATMENT METHODS

Fig 18.24 Retraction of the sternomastoid and sternohyoid muscles

Fig 18.25 Attach stay sutures

Fig 18.26 Tracheotomy

Fig 18.27 Insert the tracheotomy tube (towards lung)

Fig 18.28 Fixate the tracheotomy tube/skin suture

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BANDAGES

563

Schröder-Thomas Dressing Indication • (Obsolete) support dressing for tibia/radius and ulna fractures Schröder-Thomas Dressing

Fig 23.51 Schröder-Thomas splint (forelimb)

Fig 23.52 Schröder-Thomas splint (hind limb)

Method • Technique – Treat the wound – Cover the wound (gauze swab) – Apply a gauze dressing – Pre-bend the splint (oval aluminium tube 1.5 turns + U-shaped tube) – Pad the tube – Apply the splint Gauze tension dressing – Femur (paw: distal tension, metatarsalia: posterior tension, femur: anterior tension) – Humerus (paw: distal tension, humerus: posterior tension) Complications • Rotation • Pressure necrosis

492

TREATMENT METHODS

Inhalation Therapy Indication • Inhalation of medication via the breathing air (antibiotics, antimycotics, acetylcysteine) • Bronchopneumonia Inhalation Therapy

Fig 18.29 Parey-Boy®-Inhalator

Method • Preparation – Oxygen tent/modified Elizabethan collar, cage or transport box covered with cling film – Inhalator: Parey-Boy® • Technique – dilute medications with water/saline

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19 Parenteral Nutrition Pharyngostomy Tube Indication • Inappetence/dysphagia (difficulty in swallowing/chewing) Pharyngostomy Tube

Fig 19.1 Palpation of the puncture site

Fig 19.2 Insertion of a pair of curved artery forceps

Fig 19.3 Skin incision over the tip of the artery forceps

Fig 19.4 Advance the artery forceps through the opening

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494

TREATMENT METHODS

Fig 19.5 Pull the tube into the mouth

Fig 19.6 Push the tube into the oesophagus and stomach

Method • Preparation – Sedation – Possibly endotracheal intubation • Technique – Palpate the puncture site through the mouth (hyoid bone and mandible) – Consider marking the puncture site on the skin – Feed a curved artery forceps through the mouth to the puncture site – Palpate the puncture site over the tip of the artery forceps – Make an incision over the tip of the artery forceps – Advance the artery forceps until it is visible through the incision

– Open the artery forceps and grasp the tube with it – Pull the tube with the artery forceps through the mouth – Push the tip of the tube manually into the oesophagus and stomach – Fixate the tube with adhesive tape and a skin suture – Place a bandage and Elizabethan collar • Care/maintenance – Flush the tube before and after each application of nutritional fluid with saline – Daily dressing change Complications • Haemorrhages • Infection

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568

TREATMENT METHODS

Hoppel-Sling Bandage Indication • Relief dressing after pelvic trauma (distal bandage) • Relief dressing following reposition of the hip joint (proximal bandage) Hoppel-Sling Bandage

Fig 23.67 Proximal Hoppel sling (step 1)

Fig 23.68 Proximal Hoppel sling (step 2)

Fig 23.69 Distal Hoppel sling

Method • Technique – Gauze dressing/adhesive tape dressing Complications • Dressing might slip off

496

TREATMENT METHODS

Fig 19.11 Puncture of the stomach

Fig 19.12 Removal of the stylet

Fig 19.13 Feed the double thread through the catheter

Fig 19.14 Pull the double thread through the mouth

INDEX

echocardiography 88–104; findings 99–104; method 98; positioning of patient and transducer 88–97 ectoparasites 32, 404, 407, 409 Ehmer-sling bandage 564–5 elastic bandages 558–9 elbow joint: access to 301, 312; arthrosis 285; dressing 555; intraarticular injection 427; luxation 285; osteochondrosis dissecans (OCD) 286; X-ray findings 285–6 electrical alternans 79, 85 Elizabethan collar 494, 498–9, 507, 532, 542; modified 482–3, 492 emergency intubation 487–8 endo-/myocarditis 102 endoscopy: gastrointestinal 176–82; gynaecological 231; orthopaedic 298–302; respiratory 129–32; urological 206–7 endoscopy channel 299–300 endotracheal intubation 484–8 endotracheal lavage 145–8 eruption/lichenification 397 eversion of the nictitating membrane 367 examination methods: andrological 236–43; blood sampling 11–15; cardiological 50–114; dermatological 393–413; gastrointestinal 153–94; general 1–15; gynaecological 225–35; neurological 314–55; opthalmological 356–83; orthopaedic 244–313; otological 384–92; respiratory 115–52; restraining methods 1–10; samples processing 16–49; urological 195–224 excoriation 396 excretory ducts, salivary glands 357 excretory urography 202, 204 extensor carpi radialis reflex 324, 326–8 external ear canal swab sample 391 eye: anatomy 373; eyeball compressionauscultation 334; eyeball/globe inspection 358; eye/bulbus position 338; eye/conjunctivae inspection 357; eye/globe position 334, 336; eyelids 358; injection into the chamber 431–2; mobility and movements 331, 334–6, 338, 359, 385; subconjunctival injection 430; symmetry 356; ultrasound 379–80 facial sensitivity 332, 335, 337, 339 facial symmetry 332, 335, 337, 339, 356 faecal impaction 170 faecal samples processing 46–9 female genital organs 232

571

femoral arterial pulse 52, 54–6, 59 femur puncture site 450 fine needle biopsy 23–5, 142, 187, 189, 411–13 first grade AV-block 83–4 fissure (fissura) 398 flea check with comb 404 flexible endoscope 131, 135, 138, 140–1, 146, 176, 207, 213 flotation 46–7, 49 fluid puncture in dorsal subachroid space 350–1 fluid thrill 53–6 fluorescein test 366 flushes 523–41; anal sac lavage 536–7; colonic lavage 534–6; ear 528–30; gastric lavage 533–4; nasal 523–4; nasolacrimal duct 372, 526–7; orthograde nasal 525–6; peritoneal lavage 531–2; urethral lavage 538–41 flushing channel access 298, 301 FLUTD 200 following movement test 359–60 forelimb: dressing 551–2; innervation areas/dermatomes 341; muscle injection 418; palpation 249–53, 261, 263–4; X-ray 270–2 fractures: hip joint 292; humerus 287; knee joint 290; shoulder joint 287; tarsal joint 289 gag reflex 333 gait 244–5, 315–16, 385 gall bladder: stones 169; ultrasound image 184 gastric dilation 169 gastric foreign body 170 gastric lavage 533–4 gastric volvulus 169 gastrointestinal examination methods 153–94; abdominocentesis 193–4; auscultation 164; biopsy 188–92; case history 153; contrast medium study 173–5; endoscopy/coloscopy 180–2; endoscopy/gastroscopy 176–9; inspection 153–6; lymph node biopsy 187; palpation 157–62; percussion 163; rectal swab sample 192; ultrasound examination of abdomen 183–6; X-ray study 165–72 gastroscopy 176–9 glossal mobility 333, 335, 337, 339 gonioscopy 368–9 gynaecological examination methods 225–35; biopsy 235; case history 225;

498

TREATMENT METHODS

– Inflate the stomach with air – Localise the puncture site on the left abdominal wall caudal of the ribs (light beam of the gastroscope is visible through the abdominal wall) – Puncture the stomach above the light source with the puncture cannula and plastic catheter – Remove the stylet – Attach a guiding aid and feed the double thread through the catheter, until it is visible through the endoscope – Draw back the guiding aid (air valve seal) – Insert the biopsy forceps into the biopsy channel of the endoscope – Grab the double thread with the biopsy forceps – Pull the double thread and the endoscope out through the mouth – Tie the double thread together with the PEG tube – Pull the PEG tube into the stomach by pulling slowly on the other end of the double thread – Pull the PEG tube and the plastic catheter through the abdominal wall, until the internal bumper lies flat against the stomach wall – Cut the double thread at the base of the tube – Fixate the PEG tube with the external bumper – Attach the tubing clamp – Cut off the end of the PEG tube – Place attachments – Apply a dressing – Use an Elizabethan collar • Care/maintenance – Flush the tube before and after each application of nutritional fluid with saline – Daily dressing change – Rotate and shift the tube daily Complications • • • • •

Pressure necrosis (stomach) Infection Peritonitis Ingrowth of the tube Vomitus

PARENTERAL NUTRITION

499

Nasogastric Tube Indication • Dysphagia without obstruction Nasogastric Tube

Fig 19.19 Insert the gastric tube through the nose

Method • Preparation – Possibly slight sedation – Standing/sternal or prone position • Technique – Apply a lidocaine solution intranasally – Moisten the nasogastric tube with lidocaine gel – Insert the nasogastric tube slowly into the stomach while the head is slightly flexed – Palpate the larynx in order to stimulate swallowing

Fig 19.20 Fixate the nasogastric tube

– Check the correct position of the tube inside the stomach: visual control through the mouth – Instil 2ml of saline (this causes a cough in case of an intratracheal placement) – Fixate the nasogastric tube via adhesive tape and skin suture – Use an Elizabethan collar – Check the correct position with an X-ray • Care/maintenance – Flush the tube before and after each application of nutritional fluid with saline

20 Urinary Catheter Urethral Catheter Indication • Urine drainage in case of urinary retention/overflow bladder • Placeholder during penis amputation, perineal hernia operations Urinary catheter in the male dog

Fig 20.1 Extrude the penis

Fig 20.3 Position of the urinary catheter

Fig 20.2 Insert the urinary catheter

576

INDEX

strabismus 314, 356; stranguria 195, 236; stridor 115; syncope 50, 314; tachycardia 471, 476; tachypnoea 471, 477; tenesmus 153, 236; testicular enlargement/ painfulness 236; tetany 314; torticollis 314; tremor 314; urinary incontinence 195, 314; urinary retention 195, 314; urticaria 471, 476–7; vaginal discharge 225; vomitus 153, 195, 314, 471, 477; weight loss 50, 153 syringe driver 464–6 table edge responses 321–3, 359–60 tail dressing 550 tarsal joint: access to 301, 312; intraarticular injection 427; osteochondrosis dissecans (OCD) 289; X-ray findings 289 taste test 332, 335, 337, 339 tear swab sample 365 teats palpation 227–8 tension views (X-ray) 347 testicle cross section 242 third-degree AV-block 84–5 thoracic dressing 548 thoracic effusion 127 thoracic percussion areas and technique 118–19 thoracic spine: X-ray 346–7 thoracocentesis 508–11; cardiological 109–10; respiratory 151–2 thrombembolism 126 through-the-needle catheter 437–40 thymoma 127 thyroid palpation 52, 54–6 tibialis anterior reflex 328 tibial nerve 343 tissue sample biopsy 26–8 tonic neck reaction 321–3 tonometry 370–1 Tonopen® tonometry 370–1 topical anaesthesia 367, 450 tracheal collapse 124 tracheal foreign body 124 trachea palpation 53–6 tracheo-bronchial lavage 145 tracheo-bronchoscopy 135–7 tracheotomy 489–91 transfusion 467–81; autotransfusion 479–81; full blood transfusion 467–77; preserved blood units preparation 477–8; volume 469, 474 transport 4 transthoracic biopsy of the lung 143–4 transtracheal lavage 149–50

treatment methods: bandages 542–68; drainage 508–22; flushes 523–41; infusion 453–66; inhalation 482–92; injection 415–32; parenteral nutrition 493–9; transfusion 467–81; urinary catheter 500–7; venous access 433–52 triceps/forelimb muscle injection 418 triceps reflex 324, 326–8 tricuspid valve insufficiency 100 trochanteric fossa 450 true-cut biopsy 189 tumours: biopsy 188, 412–13; fine needle aspiration biopsy 412–13; heart 102; intestines 170; mandibular 279; nasal cavity 124; osteolytic digital 282; ovarian 230; pulmonary 126; splenic 169 tympanic bulla 390 tympanic membrane 388 ulcus 398 ulnar nerve 341 ultrasound examination: andrological 241–2; cardiological 88–104; gastrointestinal 183–6; gynaecological 232–4; opthalmological 379–80; orthopaedic 303; urological 208–10 umbilical hernia 168 unilateral renomegaly 200 unilateral thoracic effusion 127 ununited anconeal/coronoid/medial coronoid process 285–6 ureters visualisation 202 urethral lavage: flushes 538–41 urethro-cystoscopy 206 urethrography 204–5 urinary bladder: biopsy 211–13; palpation 196; ultrasound 208 urinary catheter 215–21, 500–7; females 218–21; males 215–17 urine chemistry 40, 45 urine samples processing 40–5 urological examination methods 195–224; abdominocentesis 223–4; biopsy 211–15; case history 195; contrast medium study 202–5; cystocentesis 221–2; endoscopy 206–7; inspection 195; palpation 196–7; ultrasound examination 208–10; urinary catheter 215–21; X-ray study 198–201 uterus: cross section 233; palpation 227 vaginal smear 235 vaginoscopy 231 Velpeau-sling bandage 566

502

TREATMENT METHODS

Urinary Catheter in the Male Cat

Fig 20.4 Extrude and horizontalise the penis

Fig 20.5 Insert the urinary catheter

Method • Preparation – Sedation – Dorsal position – Extrude and horizontalise the penis – Apply some sterile lubrication gel/saline onto the tip of the urinary catheter • Technique – Fixate the penis at the prepuce – Insert the urinary catheter into the urethra (sterility) until it reaches the bladder neck, possibly while slightly twisting it – Catch the urine in a sterile tube – Remove the urinary catheter (possibly fixate it via skin suture in case of urinary obstruction) Complications • Perforation of urethra/urinary bladder • Infection

URINARY CATHETER

503

Urinary catheter in the female dog and cat: flexible catheter

Fig 20.6 Insert the otoscope/speculum vertically

Fig 20.7 Advance the otoscope/speculum horizontally

Fig 20.8 Insert the urinary catheter under visual control

Fig 20.9 Position of the urinary catheter

Fig 20.10 Insert the urinary catheter under digital control

Fig 20.11 Insert the metal catheter under visual control

504

TREATMENT METHODS

Method • Preparation – Standing – Part the vulvar labia – Apply some sterile lubrication gel/saline onto the tip of the urinary catheter • Technique Flexible catheter (under visual control) – Measure the length of the urinary catheter – Insert the otoscope/speculum vertically into the vulva while avoiding the clitoris (lift the speculum a little) – Advance the otoscope/speculum horizontally until the urethral opening is reached (ventral) – Insert the urinary catheter under visual control – Advance the urinary catheter – Catch the urine in a sterile tube – Remove the urinary catheter and the otoscope/speculum Flexible catheter (under digital control) – Measure the length of the urinary catheter – Insert urinary catheter vertically into the vulva using fingers while avoiding the clitoris – Advance horizontally until the urethral opening is reached – Insert the urinary catheter digitally into the urethra – Advance the urinary catheter – Catch the urine in a sterile tube – Remove the urinary catheter Metal catheter (under visual control) – Insert the speculum vertically into the vulva while avoiding the clitoris (lift the speculum a little) – Advance the speculum horizontally until the urethral opening is reached (ventral) – Spread the speculum – Insert the urinary catheter under visual control – Advance the urinary catheter – Catch the urine in a sterile tube – Remove the urinary catheter and the speculum Complications • Perforation of the urethra/bladder • Infection

URINARY CATHETER

505

Pre-Pubic Urinary Catheter Indication • Urine drainage in neurogenic micturition disorders Pre-Pubic Urinary Catheter

Fig 20.12 Urinary catheterisation

Fig 20.13 Evacuation of the urinary bladder

Fig 20.14 Filling of the urinary bladder with physiological saline

Fig 20.15 Manual fixation of the urinary bladder

506

TREATMENT METHODS

Fig 20.16 Cystocentesis/catheter with a splittable cannula

Fig 20.17 Removal of the stylet

Fig 20.18 Insert the Foley catheter into the cannula

Fig 20.19 Inflate the Foley catheter balloon

Fig 20.20 Divide and remove the catheter

Fig 20.21 Fixation on the skin/bandage

URINARY CATHETER

507

Method • Preparation – Sedation – Dorsal position/lateral recumbency – Clip the fur/disinfect the skin – Catheterize and fill the urinary bladder with physiological saline • Technique – Fixate the urinary bladder manually – Make a stab incision of the skin paramedian over the puncture site – Puncture the urinary bladder with a catheter containing a splittable cannula (Splittocan®, Peel-Away® Catheter) – Insert a Foley catheter through the cannula (Foley catheter 5F, 12 inch) – Inflate the Foley catheter balloon with physiological saline – Evacuate the urinary bladder – Pull the Foley catheter back to the abdominal wall – Check the correct position via X-rays or ultrasound – Fixate the catheter to the skin with exiting of the catheter caudal of the shoulder) – Apply a bandage with antibiotic cream/Elizabethan collar Care/maintenance – Evacuate the urinary bladder 3–4 times daily – Instil 5ml of lavasept® solution 0.05 per cent after the bladder has been emptied – Bandage change Complications • • • •

Infection (cystitis/peritonitis) Uroabdomen Necrosis of the bladder wall Patient may pull out the catheter

21 Drainage Thoracocentesis/Thoracic Drainage Indication • Relief of a thoracic effusion • Relief of a tension pneumothorax Thoracocentesis

Fig 21.1 Puncture site for the drainage of a thoracic effusion

Fig 21.2 Puncture of the thorax cranial to the rib

Fig 21.3 Puncture of the thorax with a needle and syringe

Fig 21.4 Puncture of the thorax with a butterfly catheter

DRAINAGE

509

Method • Preparation – While the patient is standing on the examination table clip the fur and disinfect the skin (left/right thoracic wall) – System: 10ml syringe with three-way tap and an attached cannula or butterfly catheter (cat) • Technique – Puncture site: cranial of the rib in the seventh–eighth intercostal space, dorsal (if pneumothorax), ventral (if pleural effusion) – Push the skin to cranial – Puncture the thoracic wall slowly – Aspirate air/fluid until a negative pressure has been created – Possibly close the three-way tap, change the syringe, open the three-way tap again and repeat aspiration – Remove the puncture needle while maintaining the insertion angle – Let go of the skin that was previously moved forward – Compress the puncture site (2–5 min) – Examine/process the sample – Take control radiographs Complications • • • •

Thoracic haemorrhage (rib vessels, lung puncture) Pneumothorax (lung puncture, leak) Subcutaneous emphysema Infection

510

TREATMENT METHODS

Thoracic Drainage

Fig 21.5 Puncture sites for air and effusive drainage

Fig 21.6 Puncture of the thorax cranial to the rib

Fig 21.7 Puncture of the thorax

Fig 21.8 Insertion of the thoracic drain over the trocar

Fig 21.9 Attachment of the syringe and opening of the two-way tap

Fig 21.10 Thoracic drain with a valve and gaiter

DRAINAGE

511

Method • Preparation – While the patient is standing on the examination table – Clip the fur and disinfect the skin – Subcutaneous topical anaesthesia – System: drain (8,5 FR), two-way tap, trocar (Global Veterinary Prod.) • Technique – Puncture site: cranial of the rib in the seventh–eighth intercostal space, dorsal (in case of pneumothorax), ventral (in case of thoracic effusion) – Push the skin towards cranial – Close the two-way tap – Puncture the thorax – Insert the drain towards cranial over the trocar – Remove the trocar – Fixate the drain to the skin – Drain the fluid/air (suction pump/syringe) – In case of pneumothorax: attach a valve (Heimlich valve/Leo valve) and gaiter – Take control radiographs – Thoracic bandage Complications • • • •

Thoracic haemorrhage (rib vessels, lung puncture) Pneumothorax (lung puncture, leak) Subcutaneous emphysema Infection

512

TREATMENT METHODS

Pericardiocentesis/Pericardial Drainage Indication • Relief of a pericardial effusion Pericardiocentesis

Fig 21.11 Puncture site

Fig 21.12 Puncture of the thorax cranial to the rib

Fig 21.13 Pericardial puncture with a needle and syringe

Fig 21.14 Aspiration

DRAINAGE

513

Method • Preparation – Position: left lateral recumbency, sternal, possibly standing – Clip the fur and disinfect the skin – System: venous catheter, three-way tap, syringe – ECG-control – Ultrasound-control • Technique – Push the skin over the puncture site towards cranial – Pericardial puncture: right thoracic wall, in the fifth intercostal space, cranial of the rib near the chondrocostal junction, puncture horizontally while lightly aspirating – Drainage – Change the syringe after closing the three-way tap – Remove the puncture cannula and compress the puncture site – Check if the aspirate is coagulating: no coagulation in case of a pericardial effusion, coagulation in case of a cardiac puncture – Take control radiographs Complications • • • • • • •

Haemorrhage Pneumothorax Ventricular ectopic complexes Heart perforation Lung perforation Infection Recurrence

514

TREATMENT METHODS

Pericardial Drainage (Venous catheter)

Fig 21.15 Puncture site for the pericardial drainage

Fig 21.16 Puncture cranial of the rib

Fig 21.17 Pericardial puncture with a venous catheter

Fig 21.18 Removal of the stylet

Fig 21.19 Attachment of the three-way tap/syringe and aspiration

DRAINAGE

515

Method • Preparation – Position: left lateral recumbency, sternal, possibly standing – Clip the fur and disinfect the skin – System: venous catheter, three-way tap, syringe – ECG-control – Ultrasound-control • Technique – Push the skin over the puncture site towards cranial – Perform a pericardial puncture with the venous catheter system – Right thoracic wall, fifth intercostal space, cranial of the rib near the chondrocostal junction – Puncture horizontally, until the fluid flows into the catheter – Remove the stylet while fixating the catheter – Attach the syringe with the three-way tap/apply suction – Drain – Change the syringe after closing the three-way tap – Remove the puncture cannula and compress the puncture site – Check if the aspirate is coagulating: no coagulation in case of a pericardial effusion, coagulation in case of a cardiac puncture – Take control radiographs Complications • • • • • • •

Haemorrhage Pneumothorax Ventricular ectopic complexes Heart perforation Lung perforation Infection Recurrence

516

TREATMENT METHODS

Pericardial Drainage (Pigtail catheter)

Fig 21.20 Push the straightener forwards

Fig 21.21 Insert the steel stylet

Fig 21.22 Puncture site

Fig 21.23 Puncture cranial of the rib

Fig 21.24 Pericardial puncture (cross section)

Fig 21.25 Push the pigtail catheter forwards

DRAINAGE

517

Fig 21.26 Attach a syringe and aspirate

– Right thoracic wall, fifth intercostal space, cranial of the rib near the chondrocostal junction – puncture horizontally, until the fluid flows into the catheter – Remove the stylet while fixating the catheter – Close the two-way tap – Advance the pigtail catheter – Attach a syringe with a twoway tap/suction and drainage – Take control radiographs

Method • Preparation – Positioning: left lateral recumbency, sternal or prone position, possibly standing – Clip the fur, disinfect the skin – System: Pigtail catheter with a two-way tap, syringe – ECG control – Ultrasound control – Pigtail catheter: push the straightener forwards and insert the steel stylet • Technique – Push the skin over the puncture site towards cranial – Perform a pericardial puncture with the pigtail catheter system (two-way tap open)

Complications • • • • • •

Haemorrhage Perforation of the heart Ventricular extrasystole Pneumothorax Perforation of the lung Infection

518

TREATMENT METHODS

Abdominocentesis/Abdominal Drainage Indication • Relief of an abdominal effusion Abdominocentesis

Fig 21.27 Puncture site for abdominocentesis

Fig 21.28 Abdominal puncture with a syringe/needle and aspiration

Method • Preparation – Lateral recumbency – Clip the fur and disinfect the skin • Technique – Possibly evacuation of urinary bladder required – Puncture the abdominal wall paramedian and caudal of the umbilicus (use a syringe with an attached hypodermic needle) – Direct the puncture needle towards caudal – Aspirate – Remove the syringe and needle Complications • • • •

Splenic puncture Intestinal puncture Puncture of the urinary bladder Peritonitis

DRAINAGE

519

Abdominal Drainage/Peritoneal Drainage

Fig 21.29 Cutting holes into a plastic venous catheter

Fig 21.30 Modified venous catheter with holes

Fig 21.31 Puncture site for abdominal drainage

Fig 21.32 Abdominal puncture with a venous catheter

Fig 21.33 Removal of the steel stylet

Fig 21.34 Advancement of the venous catheter

520

TREATMENT METHODS

Fig 21.35 Attachment of the syringe and aspiration

Method • Preparation – Lateral recumbency – Clip the fur/disinfect the skin • Technique – Cut holes into a large venous catheter – Possibly empty the bladder – Puncture the abdominal wall carefully paramedian and caudal to the umbilicus – Direct the puncture needle towards caudal – Withdraw the steel stylet – Advance the plastic catheter – Remove the steel stylet – Insert the plastic catheter – Attach the syringe – Aspirate Complications • Blockage of the catheter/rearrangement by the greater omentum • Intestinal puncture • Puncture of the urinary bladder

DRAINAGE

521

Paracentesis Indication • Relief of a middle ear effusion by puncture of the tympanic membrane Paracentesis/Myringotomy

Fig 21.36 Otoscopic examination

Fig 21.37 Puncture site of the tympanic membrane for paracentesis

Fig 21.38 Paracentesis with a paracentesis knife

Fig 21.39 Suction of the secretion in the external ear canal/in front of the tympanic membrane

522

TREATMENT METHODS

Method • Preparation – Sternal/prone position • Technique – Otoscopic examination – X-ray examination (tympanic bulla) – Clean the external ear canal – Puncture the tympanic membrane with a paracentesis knife in the lower right quadrant – Suction the secretion off in the external ear canal outside the tympanic membrane – Insert 4–5 drops of ciprofloxacin/enrofloxacin injection solution into the external ear canal Complications • Damage to the auditory ossicles while puncturing the tympanic membrane • Accidental suction of the auditory ossicles

22 Flushes Nasal Flush Indication • Obstructive rhinitis • Foreign bodies beyond the reach for the endoscope Retrograde Nasal Flush

Fig 22.1 Endotracheal intubation

Fig 22.2 Cuffing of the endotracheal tube

Fig 22.3 Endonasal insertion of a Foley catheter

Fig 22.4 Inflation of the balloon of the Foley catheter

524

TREATMENT METHODS

Fig 22.5 Retrograde nasal flush

Method • Preparation – General anaesthesia – Lateral recumbency with lowered head position – Endotracheal intubation with cuffing of the tube • Technique – Insertion of a Foley catheter (5F) endonasally for 1–2cm into the dorsal nasal passage – Inflate the balloon of the Foley catheter with physiological saline – Flush with bodywarm saline while ensuring the patient is breathing and the fluid discharges through the oral cavity Complications • Aspiration of fluid

FLUSHES

525

Orthograde Nasal Flush

Fig 22.6 Curved artery forceps as guidance aid

Fig 22.7 Insertion of the Foley catheter through the mouth

Fig 22.8 Insertion of the Foley catheter into the nasopharynx

Fig 22.9 Inflation of the balloon of the Foley catheter

Fig 22.10 Orthograde nasal flush with bodywarm physiological saline

526

TREATMENT METHODS

Method • Preparation – General anaesthesia – Lateral recumbency with lowered head position – In combination with retrograde nasal flush in order to instil antimycotics in case of aspergillosis • Technique – Insert a Foley catheter (5F) for 1–2cm into the nasopharynx with the assistance of curved artery forceps – Inflate the balloon of the Foley catheter with physiological saline – Flush with bodywarm saline while checking the pharynx Complications • Incomplete inflation of the balloon of the Foley catheter and aspiration of fluid

Nasolacrimal Duct Flush Indication • Obstruction Nasolacrimal Duct Flush

Fig 22.11 Insertion of the cannula into the upper lacrimal opening

Fig 22.12 Hold the lower lacrimal duct opening closed and flush

FLUSHES

Fig 22.13 Insertion of the cannula into lower lacrimal duct opening

527

Fig 22.14 Hold the upper lacrimal duct opening closed and flush

Method • Preparation – Sternal/prone position – Sedation – Fluorescein test • Technique – Hold the eyelids open with one hand – Insert the flushing cannula with an attached syringe from lateral into the lacrimal duct – Compress the other lacrimal duct opening of the same eye with your fingers – Flush with bodywam physiological saline Complications • Rupture of the nasolacrimal duct in case of stenosis

528

TREATMENT METHODS

Ear Flush Indication • Cleaning of the ears prior to commencement of treatment Ear Cleaning/Ear Flush

Fig 22.15 Possibly removal of hair from the external ear canal

Fig 22.16 Otoscopic examination

Fig 22.17 Possibly removal of a foreign body (awn/grass seed)

Fig 22.18 Possibly removal of a plug with a hook

FLUSHES

Fig 22.19 Removal of wax with a cotton bud

Fig 22.20 Instil the flushing liquid

Fig 22.21 Massage flushing liquid in well

Fig 22.22 Clean/dry with cotton buds

Fig 22.23 Possibly instil medication

Fig 22.24 Massage medication in well

529

530

TREATMENT METHODS

Fig 22.25 Modified flushing catheter made from a butterfly catheter

Method • Preparation – Ear cleaning: no sedation, ear flush: sedation • Technique – Ear cleaning/ear flushing – Remove some hair from the external ear canal if required (poodle) – Otoscopic examination (contraindication for ear flush: rupture of the tympanic membrane) – Remove a plug or foreign body from the ear if present – Instil commercial ear cleaning solution into the external ear canal (until it flows over) – Massage the external ear canal – Clean and dry the external ear canal with cotton buds and cotton wool

Fig 22.26 Flush and suction while maintaining visual control

– Allow the patient to shake their head – Clean and dry the external ear canal with a cotton bud and cotton wool – Instil medication into the external ear canal if required – Massage the external ear canal Ear cleaning with a flushing catheter – Modify/cut a flushing catheter from a butterfly catheter – Attach a syringe – Insert the flushing catheter into the otoscope funnel – Flush the ears and suction off the flushing liquid Complications • Rupture of the tympanic membrane • Otitis media/vestibular syndrome in case of a ruptured tympanic membrane

FLUSHES

Peritoneal Lavage Indication • Peritonitis • Acotaemia in renal failure Peritoneal Lavage

Fig 22.27 Puncture of the abdomen

Fig 22.28 Removal of the trocar

Fig 22.29 Inlet for the flushing liquid

Fig 22.30 Outlet for the flushing liquid

531

532

TREATMENT METHODS

Method • System – 8.5 French Trocar Catheter, Global® Veterinary Products • Preparation – Lateral recumbency – Clip the fur/disinfect the skin – Topical anaesthesia – Possibly evacuation of the bladder • Technique – Puncture the abdominal wall paramedian and caudal to the umbilicus – Direct the puncture needle towards caudal – Insert the catheter with help of the trocar – Remove the trocar – Attach a three-way tap – Attach and label a 50ml syringe to the inlet and outlet of the flushing port – Fixate the catheter to the skin – Instil bodywam flushing liquid at a dose of 20ml/kg (e.g., 1 l Ringerlactate solution + 30ml Glucose 50 per cent solution) – Drain after about 30 min – Repeat the procedure after 2 hours – Apply a bandage – Use an Elizabethan collar Complications • • • •

Blockage of the catheter/rearrangement by the greater omentum Intestinal puncture Puncture of the urinary bladder Peritonitis

FLUSHES

533

Gastric Lavage Indication • Poisoning • Gastric dilation/volvulus Gastric Lavage

Fig 22.31 Insertion of a wide gastric tube

Fig 22.32 Gastric tube inside the stomach

Fig 22.33 Attach a funnel and administer the flushing liquid

Fig 22.34 Outflow of the flushing liquid into a bucket

534

TREATMENT METHODS

Method • Preparation – Sedation – Endotracheal intubation with cuffing of the tube – Dorsal position • Technique – Insert the gastric tube into the stomach (garden or industrial hose with the widest possible diameter) – Check the correct position of the gastric tube inside the stomach (via auscultation/palpation) – Hold the gastric tube up

– Attach a funnel – Instil bodywarm flushing liquid (tap water) – Let the flushing liquid run out into the bucket on the floor – Repeat the procedure until the flushing liquid looks clear – Bend and remove the gastric tube Complications • Aspiration • Perforation of the stomach/oesophagus

Colonic Lavage Indication • Constipation/coprostasis Colonic Lavage

Fig 22.35 Modified flushing catheter made from an infusion line

Fig 22.36 Flushing catheter with holes

FLUSHES

535

Fig 22.37 Insertion of the flushing catheter into the rectum

Fig 22.38 Hold the anus closed

Fig 22.39 Instillation of flushing liquid for the cat (physiological saline)

Fig 22.40 Instillation of flushing liquid for the dog (tap water)

536

TREATMENT METHODS

Method • Preparation – Sedation – Modify an infusion line by cutting end and side openings into it – Moisten the flushing catheter and anus with lubricant/paraffin • Technique – Insert the modified flushing tube into the rectum while applying manual control – Hold the anus closed with your hand – Infuse the flushing liquid into the rectum: bodywarm physiological saline in cats, bodywarm tap water in dogs

– Massage the colon manually from abdominal – Remove the hand that is holding the anus shut and let the flushing liquid run out – Repeat the procedure until all faeces have been removed from the descending colon – Remove the flushing tube Complications • • • • • • •

Haemorrhages Perforation of the colon Anaemia (cat) Hypothermia Vomitus Faecal incontinence Megacolon

Anal Sac Lavage Indication • Impaction/anal sac abscess Anal Sac Lavage

Fig 22.41 Internal expression of the anal sacs

Fig 22.42 External expression of the anal sacs

FLUSHES

Fig 22.43 Insertion of a flushing/irrigation cannula

537

Fig 22.44 Attachment of a syringe and flush

Method • Preparation – The patient is standing on the examination table – Moisten the anus with lubricant/paraffin – Express the anal sac internally • Technique – Probe the anal sac with a blunt curved lacrimal duct or irrigation cannula – Attach a syringe containing the flushing liquid (usually povidone iodine solution) – Flush the anal sac – Express the anal sac internally – Apply medication into the anal sac (usually an antibiotic) Complications • Damage to the excretory duct • Perforation of the anal sac • Painfulness

538

TREATMENT METHODS

Urethral Lavage Indication • Obstruction of the urinary tract/urolithiasis Urethral lavage in the male cat

Fig 22.45 Extrusion and horizontalisation of the penis

Fig 22.47 Urethral lavage

Fig 22.46 Insertion of a urinary catheter up to the obstruction

FLUSHES

539

Method • Preparation – Intravenous catheter – Infusion therapy according to the potassium level (usually physiological saline) – Sedation (usually avoidance of ketamine) – Dorsal position – Cystocentesis for pressure release – Extrusion and horizontalisation of the penis – Application of sterile lubricant/saline onto the tip of the urinary catheter • Technique – Fixate the penis at the prepuce – Insert the urinary catheter into the urethra under sterile conditions until the obstruction is reached, possibly while rotating it slightly – Perform a urethral lavage with bodywarm physiological saline (5ml syringe) – Insert the urinary catheter into the bladder while flushing – Fixate the urinary catheter on the skin Complications • Perforation of the urethra • Initial hyperkalaemia, in post-obstructive polyuric phase, hypokalaemia

540

TREATMENT METHODS

Urethral lavage in the male dog: urohydropulsion

Fig 22.48 Extrusion of the penis

Fig 22.49 Digital occlusion of the distal urethra

Fig 22.50 Digital occlusion of the urethral opening

FLUSHES

541

Method • Preparation – Intravenous catheter – Infusion therapy according to the potassium level (usually physiological saline) – Possibly sedation (usually avoidance of ketamine) – Dorsal position or lateral recumbency – Possibly cystocentesis for pressure release – Extrusion of the penis – Apply sterile lubricant/physiological saline onto the tip of the urinary catheter • Technique – Fixate the penis on the penis bone – Insert the urinary catheter into the urethra until the obstruction is reached (uroliths) – Occlude the distal urethra via rectal digital pressure – Flush with physiolical saline (10ml syringe) for urethral dilation – Release the digital pressure – Flush while occluding the urethral opening Complications • Perforation of the urethra or urinary bladder • Infection • Hyperkalaemia/hypokalaemia

23 Bandages Ruff Indication • Licking of wounds • Self-mutilation Elizabethan Collar

Fig 23.1 Elizabethan collar/pet cone

Fig 23.2 Neck brace

Method • Technique – Choose the appropriate size: it should reach a few cm beyond the tip of the nose – Assemble the collar according to the model instructions (usual strap guide out-in-out) – Attach to the dog’s usual collar or a doubled gauze strip for the cat

– Leave a space of two fingers width between the collar and the ventral neck Complications • • • • •

Panic Impaired movement Inappetence Collar slips off Catching of limbs inside the cone (cat) • Local skin irritation

BANDAGES

543

Spray/Plaster/Stulpa Dressing Indication • Protective dressing after surgical procedures Spray/Plaster/Stulpa Dressing

Fig 23.3 Plaster

Fig 23.4 Stulpa dressing

Method • Technique Spray dressing – Aluminium spray, methylenblue spray – Plaster – Clip the fur – Clean and disinfect the wound – Apply surgical adhesive spray around the edges of the plaster if required – Cut to use (rounding of the edges as necessary) and apply the plaster

Stulpa Dressing – Choose the appropriate size – Cut to use (openings for the forelimbs) – Put on the dressing (from cranial to caudal) – Fixate the dressing (knotting over the gluteal region) Complications • Skin irritation

544

TREATMENT METHODS

Ear Dressing Indication • Protective dressing after surgical procedures Wound Dressing

Fig 23.5 Unilateral ear dressing (step 1)

Fig 23.6 Unilateral ear dressing (step 2)

Method • Technique – Fold the affected ear over the top of the head – Possibly fixate the external side of the ear with double-sided adhesive tape – Place a swab onto the internal side of the ear – Apply a cotton wool dressing that leaves the healthy ear out – Add an elastic gauze dressing – Possibly fixate the edges of the dressing to the fur with adhesive tape – Leave a space of two fingers width between collar and ventral neck Complications • Dressing might slip • Otitis externa

BANDAGES

Bilateral Ear Dressing

Fig 23.7 Bilateral ear dressing (step 1)

Fig 23.8 Bilateral ear dressing (step 2)

Fig 23.9 Bilateral ear dressing (step 3)

Method • Technique – Place a wide adhesive strip onto the top of the head – Fold both ears onto adhesive strip – Fold the adhesive strip over – Apply stulpa head dressing (alternatively a pair of tights can be used) Complications • Dressing might slip • Otitis externa

545

546

TREATMENT METHODS

Corrective Dressing

Fig 23.10 Unilateral corrective dressing (step 1)

Fig 23.11 Unilateral corrective dressing (step 2)

Fig 23.12 Bilateral corrective dressing (step 1)

Fig 23.13 Bilateral corrective dressing (step 2)

Method • Technique Unilateral – Place a gauze roll to the inside of the pinna – Apply an adhesive ear dressing Bilateral – Place two layers of adhesive dressing against each other to the inside and outside of each ear – Apply an adhesive ear dressing for each ear Complications • Dressing might slip

BANDAGES

547

Head/Neck Dressing Indication • Wound dressing Head/Neck Dressing

Fig 23.14 Head dressing

Fig 23.15 Neck dressing

Method • Technique Head Dressing – Treat the wound – Apply a cotton wool dressing (in crossover pattern while leaving the ears outside of the dressing) – Apply an elastic gauze dressing – Possibly fixate the edges of the dressing to the fur with adhesive tape – Leave a space of two fingers width between the collar and the ventral neck

Neck Dressing – Treat the wound – Apply a cotton wool dressing (in crossover pattern) – Apply an elastic gauze dressing – Fixate the edges of the dressing to the fur with adhesive tape – Leave a space of two fingers width between collar and ventral neck Complications • Dressing might slip off • Breathing/swallowing difficulties

548

TREATMENT METHODS

Thoracic Dressing Indication • Wound dressing • Protective dressing (thoracic drainage) Thoracic Dressing

Fig 23.16 Thoracic dressing (lateral view)

Fig 23.17 Thoracic dressing (cranial view)

Method • Technique – Treat the wound – Apply a cotton wool dressing (crossover pattern) – Apply an elastic gauze dressing (crossover pattern) – Fixate the edges of the dressing to the fur with adhesive tape – Leave a space of two fingers width between the collar and the ventral neck Complications • Dressing might slip off • Breathing difficulties

BANDAGES

549

Abdominal Dressing Indication • Wound Dressing • Protective Dressing (drains) Abdominal Dressing

Fig 23.18 Abdominal dressing (lateral view)

Fig 23.19 Abdominal dressing (caudal view)

Method • Technique – Treat the wound – Apply a cotton wool dressing (crossover pattern) while leaving the body orifices out – Apply an elastic gauze dressing (crossover pattern) while leaving the body orifices out – Fixate the edges of the dressing to the fur with adhesive tape – Leave a space of two fingers width between collar and ventral neck Complications • Dressing might slip off • Soiling

550

TREATMENT METHODS

Tail Dressing Indication • Wound dressing • Protective dressing Tail Dressing

Fig 23.20 Padded tail dressing

Method • Technique – Treat the wound – Cover the wound (gauze swab) – Apply an elastic gauze dressing (crossover pattern) – Fixate the edges of the dressing to the fur with adhesive tape Complications • Dressing might slip

BANDAGES

551

Bandage for the Forelimb Indication • Wound dressing • Protective dressing

Fig 23.23 Elastic gauze dressing (including elbow/carpal joint)

including carpal joint

Fig 23.22 Cotton wool dressing (including elbow/carpal joint)

including elbow joint

including carpal joint

including elbow joint

Fig 23.21 Padding of the toes with cotton wool

including carpal joint

including elbow joint

Bandage for the Forelimb

Fig 23.24 Adhesive tape dressing (including elbow/carpal joint)

552

TREATMENT METHODS

Fig 23.25 Forelimb/shoulder bandage

Method • Technique – Treat the wound – Cover the wound (gauze swab)

Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the carpal/elbow joint

Padding of the toes with cotton wool – Apply four cotton wool strips between the toes Cotton wool dressing – Single/double pattern around the sole of the foot – Parallel pattern (overlay of the cotton wool strips by about 50 per cent) from the paw to proximal of the carpal joint/elbow joint

Adhesive tape dressing – Protection of the sole of the foot (four vertical strips and one transverse strip) – Fixate the edges of the gauze dressing to the fur Complications • • • •

Dressing might slip off Pressure necrosis Putrefaction Unaccepting/panic (especially cats)

BANDAGES

Bandage for the Hind Limb Indication • Wound dressing • Protective dressing (scratch protection)

including tarsal joint

including knee joint

Bandage for the Hind Limb

Fig 23.27 Cotton wool dressing (including knee/tarsal joint)

Fig 23.28 Elastic gauze dressing (including knee/tarsal joint)

including tarsal joint

including tarsal joint

including knee joint

including knee joint

Fig 23.26 Padding of the toes with cotton wool

Fig 23.29 Adhesive tape dressing (including knee/tarsal joint)

553

554

TREATMENT METHODS

Fig 23.30 Bandage of the hind limb with abdominal dressing

Method Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the tarsal/knee joint

• Technique – Treat the wound – Cover the wound (gauze swab) Padding of the toes with cotton wool – Apply four cotton wool strips between the toes Cotton wool dressing – Single/double pattern around the sole of the foot – Parallel pattern (overlay of the cotton wool strips by about 50 per cent) from the paw to proximal of the tarsal/knee joint

Adhesive tape dressing – Protection of the sole of the foot (four vertical strips and one transverse strip) – Fixate the edges of the gauze dressing to the fur Complications • • • •

Dressing might slip off Pressure necrosis Putrefaction Unaccepting/panic (especially cats)

BANDAGES

555

Elbow Dressing Indication • Wound dressing • Protective dressing Elbow Dressing

Fig 23.31 Wound dressing/cotton wool dressing

Fig 23.32 Elastic gauze dressing/adhesive tape dressing

Method • Technique – Treat the wound – Cover the wound (gauze swab) – Cotton wool dressing – Crossover pattern (from distal to proximal of the elbow joint) – Elastic gauze dressing – Crossover pattern (from distal to proximal of the elbow joint) – Adhesive tape dressing – Fixate the edges of the elastic gauze dressing to the fur Complications • Dressing might slip off • Pressure necrosis • Swelling of the distal limb

556

TREATMENT METHODS

Stifle Dressing Indication • Wound dressing • Protective dressing Stifle Dressing

Fig 23.33 Wound dressing/cotton wool dressing

Fig 23.34 Elastic gauze dressing/adhesive tape dressing

Method • Technique – Treat the wound – Cover the wound (gauze swab) Cotton wool dressing – Crossover pattern (from distal to proximal of the stifle joint) Elastic gauze dressing – Crossover pattern (from distal to proximal of the stifle joint) Adhesive tape dressing – Fixate the edges of the gauze dressing to the fur Complications • Dressing might slip off • Pressure necrosis • Swelling of the distal limb

BANDAGES

557

Robert-Jones Dressing Indication • Support dressing in acute limb trauma (fractures) Robert-Jones Dressing

Fig 23.35 Stirrups of adhesive tape

Fig 23.36 Cotton wool dressing

Fig 23.37 Elastic gauze dressing

Method • Technique – Place the adhesive stirrups on the unshaved fur – Apply a generous sized cotton wool dressing leaving the paw out – Turn the stirrups over and adhere them to the cotton wool dressing – Add a tight gauze dressing

558

TREATMENT METHODS

Elastic Bandage Indication • Support Dressing Elastic Bandage

Fig 23.38 Padding of the toes with cotton wool/cotton wool dressing

Fig 23.39 Elastic dressing

Fig 23.40 Elastic gauze dressing

Fig 23.41 Adhesive tape dressing

BANDAGES

559

Method • Technique – Treat the wound – Cover the wound (gauze swab) Padding of the toes with cotton wool – Apply four cotton wool strips between the toes – Cotton wool dressing – Single/double pattern around the sole of the foot – Parallel pattern (overlay of the cotton wool strips by about 50 per cent) from the paw to proximal of the elbow/knee joint Elastic dressing – Tight parallel pattern of elastic dressing Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the elbow/stifle joint Adhesive tape dressing – Protection of the sole of the foot (four longitudinal adhesive strips and one transverse one) – Fixate the edges of the gauze dressing on the fur Complications • • • •

Swelling Pressure necrosis Putrefaction Unacceptance/panic (especially cat)

560

TREATMENT METHODS

Splint Bandage Indication • Support dressing for immobilisation of the limb Synthetic Casting Tape

Fig 23.42 Wound dressing with padding of the toes

Fig 23.43 Cotton wool dressing

Fig 23.44 Elastic gauze dressing

Fig 23.45 Knead the cast in lukewarm water

BANDAGES

561

Fig 23.46 Synthetic casting tape (measure the length)

Fig 23.47 Synthetic casting tape (place the straps)

Fig 23.48 Synthetic casting tape (application)

Fig 23.49 Elastic gauze dressing

Fig 23.50 Adhesive tape dressing

562

TREATMENT METHODS

Method • Technique – Treat the wound – Cover the wound (gauze swab) Padding of the toes with cotton wool – Place four cotton wool strips between the toes Cotton wool dressing – Single/double pattern around the sole of the foot – Parallel pattern (overlay of the cotton wool strips by about 50 per cent) from the paw to proximal of the elbow/knee joint Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the elbow/stifle joint Synthetic casting tape – Cellacast Xtra®, Lohmann & Rauscher – Knead for 1 min in lukewarm water wearing gloves – Measure the required length on the patient – Fold the tape in overlaying strips and lay onto a table or plastic work top – Brush the dressing surface with a greasy cream – Apply the dressing – Adapt it to the shape of the limb – Round the edges off and turn them outwards (pair of dressing scissors as required) Elastic gauze dressing – Single/double pattern around the sole of the foot – Crossover pattern from the paw to proximal of the synthetic casting tape Adhesive tape dressing – Protection of the sole of the foot (four longitudinal adhesive strips and one transverse one) – Fixate the edges of the gauze dressing on the fur Complications • Swelling • Pressure necrosis

• Putrefaction • Unacceptance/panic (esp. cat)

BANDAGES

563

Schröder-Thomas Dressing Indication • (Obsolete) support dressing for tibia/radius and ulna fractures Schröder-Thomas Dressing

Fig 23.51 Schröder-Thomas splint (forelimb)

Fig 23.52 Schröder-Thomas splint (hind limb)

Method • Technique – Treat the wound – Cover the wound (gauze swab) – Apply a gauze dressing – Pre-bend the splint (oval aluminium tube 1.5 turns + U-shaped tube) – Pad the tube – Apply the splint Gauze tension dressing – Femur (paw: distal tension, metatarsalia: posterior tension, femur: anterior tension) – Humerus (paw: distal tension, humerus: posterior tension) Complications • Rotation • Pressure necrosis

564

TREATMENT METHODS

Ehmer-Sling Bandage Indication • Relief dressing following reposition of the hip joint Ehmer-Sling Bandage

Fig 23.53 Ehmer-Sling direction (step 1)

Fig 23.54 Ehmer-Sling direction (step 2)

Fig 23.55 Ehmer-Sling direction (step 3)

Fig 23.56 Ehmer-Sling direction (step 4)

BANDAGES

565

Fig 23.57 Ehmer-Sling direction (step 5)

Fig 23.58 Ehmer-Sling direction (step 6)

Fig 23.59 Ehmer-Sling direction (step 7)

Fig 23.60 Ehmer-Sling direction (step 8)

Method • Technique – Gauze dressing/adhesive tape dressing – Sling direction 1–8 Complications • Dressing might slip off • Unacceptance

566

TREATMENT METHODS

Velpeau-Sling Bandage Indication • Relief dressing after reposition of the shoulder joint/scapular fractures Velpeau-Sling Bandage

Fig 23.61 Velpeau-Sling (Step 1)

Fig 23.62 Velpeau-Sling (Step 2)

Fig 23.63 Velpeau-Sling (Step 3)

Method • Technique – Gauze dressing/adhesive tape dressing Complications • Dressing might slip off • Unacceptance

BANDAGES

Robinson-Sling Bandage Indication • Relief Dressing of a hind limb Robinson-Sling Bandage

Fig 23.64 Robinson-Sling (step 1)

Fig 23.65 Robinson-Sling (step 2)

Fig 23.66 Robinson-Sling (step 3)

Method • Technique – Gauze dressing/adhesive tape dressing Complications • Dressing might slip off

567

568

TREATMENT METHODS

Hoppel-Sling Bandage Indication • Relief dressing after pelvic trauma (distal bandage) • Relief dressing following reposition of the hip joint (proximal bandage) Hoppel-Sling Bandage

Fig 23.67 Proximal Hoppel sling (step 1)

Fig 23.68 Proximal Hoppel sling (step 2)

Fig 23.69 Distal Hoppel sling

Method • Technique – Gauze dressing/adhesive tape dressing Complications • Dressing might slip off

Index abdominal dressing 549 abdominal effusion 168 abdominal organs 159 abdominocentesis: cardiological 113–14; drainage 518–20; gastrointestinal 193–4; urological 223–4 achilles tendon reflex 325, 327–8 acquired heart diseases 104 acropachy 282 adrenal carcinoma 168 anal sac lavage 536–7 anconeal process, ununited 285 andrological examination methods 236–43; biopsy 243; case history 236; inspection 236–7; palpation 238–9; ultrasound examination 241–2; X-ray study 240 anterior eye chamber 358, 377, 382 anterior tibial reflex 325, 327–8 anticoagulant 469, 474 aortic dilation 68 arterial blood sampling 14–15 arthrocentesis 311–13 arthroscopy 298–302 arthrosis: knee joint 290; shoulder joint 288 aspiration biopsy 305–7 aspiration pneumonia 125 asystole 79, 85 atlantoaxial subluxation 280 atony of the urinary bladder 200 atrial enlargement 66–7 atrial flutters/fibrillation 82 atrial standstill 77, 82, 86 atrophy (skin) 396 atropine test 332 aural mobility 332, 335, 337, 339 auscultation: cardiological 57–62; gastrointestinal 164; respiratory 120–1 autotransfusion 479–81 avulsion: knee joint 291 axillary nerve 340 bacteriology 30–1, 42, 45–7, 49 bandages 542–68; abdominal dressing 549; ear dressings 544; Ehmer-sling 564–5; elastic 558–9; elbow dressing 555; forelimb dressing 551–2; head/neck dressing 547; hind limb dressing 553–4; Hoppel-sling

568; Robert-Jones dressing 557; Robinson-sling 567; ruffs 542; SchröderThomas dressing 563; splint 560–2; spray/plaster/stulpa dressing 543; stifle dressing 556; tail dressing 550; thoracic dressing 548; Velpeau-sling 566 behaviour 315–16 bicipital reflex 324, 327–8 bicipital tendon injection 429 bilaterall ear dressing 545 biopsy: andrological 243; bone 309; bone marrow 305–8; dermatological 411–13; external ear canal swab sample 392; gastric/intestinal 190–2; gastrointestinal 187–92; gynaecological 235; joint 304–5; kidney 214; liver 188–90; of the lung 141–4; of the lymph node 187; of the nasal mucosa 138–9; opthalmological 381–2; orthopaedic 304–10; otological 391; punch 308; respiratory 138–44; skin punch 411; of the tracheal/bronchial mucosa 140–1; tumour 188, 412–13; urinary bladder 211–13; urological 211–15 biopsy samples processing: fine needle aspiration 23–5; tissue sample 26–8 black head (comedo) 396 blink reflex 331, 335–6, 338, 361–2 blister (vesicula/bulla) 395 blood collection (transfusion) 467, 469, 472, 474–5 blood donor suitability 468, 470, 474, 476 blood pressure measurement 105 blood sample processing 16–22; serum tube 18–19; smear (EDTA tube) 16–17, 19 blood sampling 11–15; arterial 14–15; venous 11–13 blood typing 468–9, 473 bone biopsy 309 bone marrow biopsy 305–7 breathing sounds 121 bronchitis 125 bronchoscopy 135 butterfly catheter 422 calcification of the intervertebral disc 281 calculi in kidney, urethra and bladder 200 capillary refill 52, 54–5

570

INDEX

cardiac apex beat palpation 53–6 cardiological examination methods 50–114; abdominocentesis 113–14; auscultation 57–62; blood pressure measurement 105; case history 50; central venous pressure measurement (CVP) 106–8; electrocardiography (ECG) 71–87; inspection 50–1; palpation 52–6; pericardiocentesis 111–12; thoracocentesis 109–10; ultrasound examination (echocardiography) 88–104; X-ray study 63–70 cardiomegaly 66–7 carpal joint: access to 301, 312; arthrosis 283; hyperflexion/ligament rupture of the 283; intraarticular injection 426–7; rupture of the lateral ligament 284; X-ray findings 283–4 carrying 4 cauda equina: X-ray 347 caudal vena cava dilation 68 central venous catheters 437–49; over-thewire catheter 441–3; splittable cannula catheter 444–6; through-the-needle catheter 437–40; venotomy 447–9 central venous pressure measurement (CVP) 106–8 cephalic vein puncture 433 cerebrospinal fluid puncture/CSF tap 350–5 cervical spine: rotation 318; X-ray 345, 347 chamber of the eye injection 431–2 chest leads (ECG) 71 cisternal myelography 348 cisternal puncture 350, 352, 354 colon anatomy 180 colonic lavage 534–6 coloscopy 180–2 comparative digital tonometry 370 congenital heart diseases 104 conjunctivae: biopsy 381–2; inspection 357–8; swab test 365 contrast medium study: gastrointestinal 173–5; urological 202–5 coprological examination 46, 49 cornea inspection 358, 377 corneal reflex 331, 335, 337–8, 361–2 coronoid process, ununited 285 correction responses 319, 321–3 corrective ear dressing 546 coxarthrosis 293 coxa valga 293 coxa vara 293

cranial abdominal organs 183 cranial cruciate ligament rupture 291 cranial nerves 330–9 crossed extensor reflex 325 cross matching (transfusion) 469–70, 475–6 crush cages 3 crust (crusta) 397 cutaneous trunci reflex 326–9 cyst (epidermal) 398 cystocentesis 221–2 cystography 203–5 cystoscopy 206–7 cyst (subepidermal) 398 cytology 27–8, 31, 33–4, 36, 45, 311, 381, 406, 412–13 deep pain sensation 340, 343 Demodex sp. 32, 407 dens axis fractures 280 dental mirror 129, 133 dentition 154 dermatological examination methods 393–413; biopsy 411–13; case history 393; flea check with comb 404; hair samples 410; impression smears 409; inspection 393–400; olfactory test 403; palpation 401–2; skin scrapes 406–7; swab samples 408; wood-lamp examination 405 dermatomes 341–3 diaphragmatic hernia 127 digital luxation 282 digoxin 81–5, 87 dilated cardiomyopathy 99 direct ophthalmoscopy 374, 376 discospondylitis 280 distal ulna bone cyst 284 doppler echocardiography see echocardiography dorsal lumbar muscle injection 418–19 dorsal subachroid space: fluid puncture 350–1 drainage 508–22; abdominocentesis 518–20; paracentesis 521–2; pericardiocentesis 512–17; thoracocentesis 508–11 duodenum anatomical regions 176 dura mater/arachnoid punture 351 ear: anatomy 388; external canal swab sample 391; flush 528–30; inspection 384; mobility 332, 335, 337, 339 ECG (electrocardiography) 71–87; chest and limb leads 71; device operation 72, 75; readings 73, 77–80

INDEX

echocardiography 88–104; findings 99–104; method 98; positioning of patient and transducer 88–97 ectoparasites 32, 404, 407, 409 Ehmer-sling bandage 564–5 elastic bandages 558–9 elbow joint: access to 301, 312; arthrosis 285; dressing 555; intraarticular injection 427; luxation 285; osteochondrosis dissecans (OCD) 286; X-ray findings 285–6 electrical alternans 79, 85 Elizabethan collar 494, 498–9, 507, 532, 542; modified 482–3, 492 emergency intubation 487–8 endo-/myocarditis 102 endoscopy: gastrointestinal 176–82; gynaecological 231; orthopaedic 298–302; respiratory 129–32; urological 206–7 endoscopy channel 299–300 endotracheal intubation 484–8 endotracheal lavage 145–8 eruption/lichenification 397 eversion of the nictitating membrane 367 examination methods: andrological 236–43; blood sampling 11–15; cardiological 50–114; dermatological 393–413; gastrointestinal 153–94; general 1–15; gynaecological 225–35; neurological 314–55; opthalmological 356–83; orthopaedic 244–313; otological 384–92; respiratory 115–52; restraining methods 1–10; samples processing 16–49; urological 195–224 excoriation 396 excretory ducts, salivary glands 357 excretory urography 202, 204 extensor carpi radialis reflex 324, 326–8 external ear canal swab sample 391 eye: anatomy 373; eyeball compressionauscultation 334; eyeball/globe inspection 358; eye/bulbus position 338; eye/conjunctivae inspection 357; eye/globe position 334, 336; eyelids 358; injection into the chamber 431–2; mobility and movements 331, 334–6, 338, 359, 385; subconjunctival injection 430; symmetry 356; ultrasound 379–80 facial sensitivity 332, 335, 337, 339 facial symmetry 332, 335, 337, 339, 356 faecal impaction 170 faecal samples processing 46–9 female genital organs 232

571

femoral arterial pulse 52, 54–6, 59 femur puncture site 450 fine needle biopsy 23–5, 142, 187, 189, 411–13 first grade AV-block 83–4 fissure (fissura) 398 flea check with comb 404 flexible endoscope 131, 135, 138, 140–1, 146, 176, 207, 213 flotation 46–7, 49 fluid puncture in dorsal subachroid space 350–1 fluid thrill 53–6 fluorescein test 366 flushes 523–41; anal sac lavage 536–7; colonic lavage 534–6; ear 528–30; gastric lavage 533–4; nasal 523–4; nasolacrimal duct 372, 526–7; orthograde nasal 525–6; peritoneal lavage 531–2; urethral lavage 538–41 flushing channel access 298, 301 FLUTD 200 following movement test 359–60 forelimb: dressing 551–2; innervation areas/dermatomes 341; muscle injection 418; palpation 249–53, 261, 263–4; X-ray 270–2 fractures: hip joint 292; humerus 287; knee joint 290; shoulder joint 287; tarsal joint 289 gag reflex 333 gait 244–5, 315–16, 385 gall bladder: stones 169; ultrasound image 184 gastric dilation 169 gastric foreign body 170 gastric lavage 533–4 gastric volvulus 169 gastrointestinal examination methods 153–94; abdominocentesis 193–4; auscultation 164; biopsy 188–92; case history 153; contrast medium study 173–5; endoscopy/coloscopy 180–2; endoscopy/gastroscopy 176–9; inspection 153–6; lymph node biopsy 187; palpation 157–62; percussion 163; rectal swab sample 192; ultrasound examination of abdomen 183–6; X-ray study 165–72 gastroscopy 176–9 glossal mobility 333, 335, 337, 339 gonioscopy 368–9 gynaecological examination methods 225–35; biopsy 235; case history 225;

572

INDEX

endoscopy 231; inspection 225–6; palpation 227–8; ultrasound examination 232–4; X-ray study 229–30 hair: loss (alopecia) 396; palpation 401–2; pluck sample 410; samples 38–9, 410; sticky tape impression smear 409 hapatomegaly 169 head: 90° angulation (cisternal puncture) 350; dressing 547; muscles 317; X-ray 344, 347, 378; X-ray findings 279 hearing test 333, 336–7, 339, 392 heart: cycle 58, 60; murmurs 59–62; size 64–70; sounds 57, 59–62; tumours 102; worm disease 102 hemi walking/standing responses 320, 323 hepatojugulary reflex 52, 54–6 hiatus hernia 168 hind: limb X-ray 273–6 hind limb: dressing 553–4; innervation areas/dermatomes 342–3; palpation 254–60, 262, 264 hip joint: access to 312; intraarticular injection 428; X-ray findings 292–3 holding 5–10 Hoppel-sling bandage 568 hopping responses 320–3 humerus puncture site 450 hypercalcaemia 86 hyperflexion/ligament rupture of the carpal joint 283 hyperkeratosis 396 hyperpigmentation 397 hypertrophic cardiomyopathy 99 hypocalcaemia 84–5, 87 hypokalaemia 84, 86, 539, 541 hypopigmentation 397 impression smears 409; sample processing 35–7 indirect ophthalmoscopy 375–6 infusion 453–66; intravenous (gravity assisted) 453–6; line/port 422–3; pump 460–3; subcutaneous 457–9; syringe driver 464–6 inhalation 482–92; endotracheal intubation 484–8; oxygen supplementation 482–3; therapy 492; tracheotomy 489–91 injection treatment methods 415–32; bicipital tendon 429; chamber of the eye 431–2; intraarticular 426–8; intracardiac 425; intramuscular 417–20; intraperitoneal 424; intravenous 421–3; subconjunctival 430; subcutaneous 415–16

innervation areas 341–3 intervertebral disc prolapse 280 intestines: tumour 170; ultrasound image 185 intraarticular injection 426–8 intracardiac injection 425 intramuscular injection 417–20 intraosseal venous access 450–2 intraperitoneal injection 424 intravenous catheter 422 intravenous (gravity assisted) infusion 453–6 intravenous injection 421–3 iridocorneal morphology 368 jaw occlusion 332, 335, 337, 339 joint biopsy 304 kidney: biopsy 214–15; palpation 196; size 199 kidneys: ultrasound 209 knee joint: access to 301, 312; intraarticular injection 428; osteochondrosis dissecans (OCD) 291; X-ray findings 290–1 laryngoscopy 133–4, 333, 335, 337, 339, 484 lateral cutaneus nerve of the thigh 342 lateral saphenous vein puncture 433 laying down 10 leads, doubled or fed under door 2 left atrial enlargement 67, 70, 80, 85 left ventricular enlargement 80, 86 Legg-Calves-Perthes disease 293 lens inspection 358, 377 lidocaine 87, 137, 452, 483, 499 lifting 5 limb leads (ECG) 71 limbs palpation 249–60 linear foreign body with plication of the intestines 170 liver and spleen palpation 53–6 liver ultrasound image 184–5 long digital extensor tendon avulsion 291 low voltage 79, 85 lumbar myelography 348 lumbar puncture 350, 353–5 lumbar spine X-ray 346–7 luxation: hip joint 292–3; knee joint 290; mandibular 279; shoulder joint 287; tarsal joint 289 lymph node biopsy 187 mammary strip palpation 227–8 mandibular function test 317 mandibular symphysis fracture 279

INDEX

maxillar fracture 279 mean electrical axis 74, 76, 86 medial collateral ligament rupture 291 medial coronoid process, ununited 286 medial saphenous vein puncture 434 megaoesophagus 168 menace response 330, 334, 336, 338, 361–2 mentation 315–16 microcardia 68 mitral valve insufficiency 100 monteggia fracture 285 mouth slings and muzzles 1–2 multiple myeloma 281 musculature 317–18, 334, 336–7, 339; injection 417–20 musculocutaneus nerve 341 mycology 30–2, 39, 408 mydriatic eye drops 373 myelography 348–9 myringotomy 521–2 nasal cannula 482–3 nasal cavity tumours 124 nasal flushes 523–7; nasolacrimal duct 526–7; orthograde 525–6; retrograde 523–4 nasal probe 482–3 nasal sensitivity 332, 335, 337, 339 nasogastric tube 499 nasolacrimal duct 366; flush 372, 526–7 neck: brace 542; dressing 547; musculature 334, 336–7, 339 necrosis 397 neurological examination methods 314–55; case history 314; cerebrospinal fluid puncture/CSF tap 350–5; cranial nerves 330–9; inspection 315–16; myelography 348–9; palpation 317–18; postural responses 319–23; sensory perception 340–3; spinal reflexes 324–9; X-ray study 344–7 node (nodus/tumour) 395 nodule (papula/plaque) 395 Norberg angle 276–7 obstacle course test 359–60 occipital protuberance/wing of the atlas 352 ocular/bulbus and pupillary position 330 ocular fundus 374, 377 oculo-cardial reflex 334, 336–7, 339 oesophageal foreign body 168 olfactory test 330, 334, 336, 338; dermatological 403; otological 387 ophthalmoscopy 331, 335, 337, 339, 373–7

573

opthalmological examination methods 356–83; biopsy 381–2; case history 356; eversion of the nictitating membrane 367; fluorescein test 366; flushing of the nasolacrimal duct 372; gonioscopy 368–9; inspection 356–8; penlight examination 363; during pupillary dilation 373–7; reflexes 361–2; Schirmer tear test 364; sight test 359–60; tear swab sample 365; tonometry 370–1; ultrasound examination 379–80; X-ray study 378 oral cavity inspection 385 orthograde nasal flush 525–6 orthopaedic examination methods 244–313; arthrocentesis 311–13; biopsy 304–10; case history 244; endoscopy 298–302; inspection 244–5; palpation 246–64; ultrasound examination 303; X-ray study 265–97 oscillometric blood pressure measuring 105 osteochondrosis dissecans (OCD): elbow joint 286; knee joint 291; shoulder joint 288; tarsal joint 289 osteolytic digital tumour 282 osteomyelitis 288 osteosarcoma: distal radius 283; knee joint 290; shoulder joint 288 otitis media 279 otological examination methods 384–92; biopsy 391; case history 384; hearing test 392; inspection 384–6; olfactory test 387; otoscopy 388–9; X-ray study 390 otoscope 129, 138, 231 otoscopy 333, 336–7, 339, 388–9 ovarian tumour 230 ovary ultrasonic pattern 232 over-the-wire catheter 441–3 oxygen supplementation 482–3 padding for spine X-ray 267 palpation: andrological 238–9; cardiological 52–6; dermatological 401–2; forelimb 249–53, 261, 263–4; gastrointestinal 157–62; gynaecological 227–8; hind limb 254–60, 262, 264; neurological 317–18; orthopaedic 246–64; respiratory 117–18; urological 196–7 palpebral reflex 331, 335–6, 338, 361–2 panosteitis 291 paracentesis 20–3, 521–2 paraprostatic cyst 240 parenteral nutrition 493–9; nasogastric tube 499; percutaneous endoscopic gastrostomy 495–8; pharyngostomy tube 493–4

574

INDEX

patellar reflex 324, 327–8 patellar tendon rupture 291 pathological withdrawal reflex 325, 327, 329 paw: fractures 282; X-ray findings 282 PEG tube 495–8 penlight opthalmological examination 363 percussion: gastrointestinal 163; respiratory 118–19 percutaneous endoscopic gastrostomy 495–8 perfusor 464 pericardial effusion 103 pericardiocentesis 111–12, 512–17 perineal reflex 326–9 peripheral venous catheter 433–6 peritoneal lavage 531–2 peritoneopericardial diaphragmatic hernia 103 peroneal nerve 342 persistent ductus arteriosus 101 persistent right fourth aortic arc 68 pharyngostomy tube 493–4 pigtail catheter 516–17 pimple (pustula) 395 pinna 384 plasma production 477–8 plaster dressing 543 pleural effusion 69 pneumonia 125 pneumothorax 127 posterior chamber/vitreous body 377 posture 244–5, 315–16; postural responses 319–23 pre-pubic urinary catheter 505–7 preserved blood units preparation 477–8 primary efflorescences 395, 400 prostate biopsy 243 prostatic enlargement 240 pulmonary contusion 125 pulmonary emphysema 125 pulmonary metastasis 126 pulmonary oedema 69, 125 pulmonary stenosis 101 pulmonary trunc dilation 68 pulmonary tumour 126 punch biopsy 308 puncture sites 352–3 pupillary dilation, examination during 373 pupillary inspection 358 pupillary light reflex 331, 334, 336, 338, 361–2

pupillary position 334, 336, 338 pyometra 230 quadriceps/thigh muscle injection 417–19 radial carpal bone fracture 283 radial nerve 341 radiological anatomy 63, 65 radius curvus 284 radius/ulna fracture 285 rectal examination 160 rectal swab sample 192 reflexes: opthalmological 361–2; spinal 324–9 refractometry 41, 45 renal pelvis visualisation 202 respiratory examination methods 115–52; auscultation 120–1; biopsy of the lung 141–4; biopsy of the nasal mucosa 138–9; biopsy of the tracheal/bronchial mucosa 140–1; case history 115; endoscopy 129–32; endotracheal lavage 145–8; inspection 115–16; laryngoscopy 133–4; palpation 117–18; percussion 118–19; thoracocentesis 151–2; tracheobronchoscopy 135–7; transtracheal lavage 149–50; X-ray study 124–8 restraining methods 1–10; holding 5–10; laying down 10; lifting, carrying and transport 4–5 restrictive cardiomyopathy 99 retrograde nasal flush 523–4 retroperitoneal haematoma 200 rhinoscopy 129–32 rib fracture 127 right atrial enlargement 80, 85 right axis deviation 80, 86 righting responses 320, 322–3 right ventricular enlargement 80, 86 rigid cystoscope 206, 211 rigid endoscope 130, 136, 138, 145, 231 Robert-Jones dressing 557 Robinson-sling bandage 567 ruff 542 ruptures: knee joint 291 SA-block/sinus arrest 77, 81 salivary glands 158; excretory ducts 357 samples processing 16–49; blood 16–19; faeces 46–9; fine needle aspiration biopsy 23–5; hair 38–9; impression smears 35–7; paracentesis 20–3; skin scrapes 35–7; swab samples 29–31; tissue sample biopsy 26–8; urine 40–5

INDEX

saphenus nerve 342 scale (squama) 398 scar (cicatrix) 397 Schiötz tonometer 370–1 Schirmer tear test 331, 335, 337–8, 364 Schröder-Thomas dressing 563 secondary efflorescences 396, 400 second-degree AV-block 84 Seldinger technique 487–8 semitendinous muscle injection 418 sensory perception 340–3 serum tube blood sample processing 18–19 shoulder joint: access to 301, 312; intraarticular injection 427; osteochondrosis dissecans (OCD) 288; X-ray findings 287–8 sick-sinus-syndrome 77, 81 side stepping responses 320 sight test 330, 334, 336, 338, 359–60 sinus bradycardia 77, 81 sinusitis 124 sinus tachycardia 77, 81 skin: anatomical structures 393; fine needle aspiration biopsy 412–13; inspection 394; lesions 395–8, 400; lesions (distribution) 399–400; palpation 401–2; punch biopsy 411–12; puncture 351; scrapes 35–7, 406–7; sticky tape impression smear 409; swab sample 408 skull: X-ray findings 279 slit lamp examination 368, 375–6 small intestinal foreign body 170 smear (EDTA tube) blood sample processing 16–17, 19 soft tissue puncture 351 speculum/light source 231 spinal cord cross section 350 spine: flexion and extension 317; luxation fracture 280; palpation 247–8, 318; reflexes 324–9; X-ray findings 280–1; X-ray padding and positioning 268–9 spleen ultrasound image 185 splenic torsion 169 splint bandages 560–2 splittable cannula catheter 444–6 spondylosis 281 spot (macula) 395 spray dressing 543 sticky tape impression 37 stifle dressing 556 stomach: anatomy 176; ultrasound image 184 strait jackets, sacks and towels 3 stulpa dressing 543

575

stylet removal 351 subaortic stenosis 100 subconjunctival injection 430 subcutaneous emphysema 124 subcutaneous infusion 457–9 subcutaneous injection 415–16 superficial pain sensation 340, 343 supraventricular premature complex 77, 82, 86–7 swab samples: dermatological 408; external ear canal 391; opthalmological 365; processing 29–31; vaginal mucosa 235 swallowing reflex 333, 335, 337, 339 symptoms: abdominal pain/cramps 153; alopecia 393; anaphylaxis 471, 476; anisocoria 314, 356; anorexia 195; anuria 195; ataxia 314, 384; behavioural changes 225; behavioural disorder 314; blepharospasm 356; blindness 314, 356; catalepsia 314; catalepsia/cataplexia 314; colic 153; coma 314; convulsions 314; corneal opacity 356; cough 50, 115, 471, 477; cyanosis 50, 115; deafness 314; diarrhoea 153; dysphagia 153, 314; ectropium 356; efflorescences of the skin 393; emesis 153; enophthalmus 356; entropium 356; erectile dysfunction 236; excitation 471, 476; exophthalmus 356; eyesight loss 314, 356; faecal impaction 153, 236; fever 471, 477; haematochezia 236; haematuria 195, 236; haemoglobinaemia/-uria 471, 476; halithosis 195; head shaking/scratching 384; head tilt 314, 384; hearing loss 314; hyperaesthesia 314; hypersalivation 153; inappetence 153, 195; irregular oestrus cycle 225; lameness 244; lens opacity 356; licking of the anal region 153; mammary discharge 225; miosis 356; mydriasis 356; narcolepsia 314; nasal discharge 115; nictitating membrane prolapse 356; nocturnal unrest 50; nystagmus 314, 356, 384; ocular discharge 356; oliguria 195; opisthotonus 314; paralysis 314; paraparesis 50; paresis 314; penile discharge 236; performance insufficiency 50; pollakisuria 195, 236; polydipsia 195, 225, 314; polyphagia 153; polyuria 225; prolapse of nictitating membrane 356; pruritus 393; pulmonary oedema 471, 477; red eye 356; regurgitation 153; renal failure 471, 476; respiratory distress 50, 115; SchiffSherington syndrome 314; scooting 153; shock 471, 477; sneezing 115; stertor 115;

576

INDEX

strabismus 314, 356; stranguria 195, 236; stridor 115; syncope 50, 314; tachycardia 471, 476; tachypnoea 471, 477; tenesmus 153, 236; testicular enlargement/ painfulness 236; tetany 314; torticollis 314; tremor 314; urinary incontinence 195, 314; urinary retention 195, 314; urticaria 471, 476–7; vaginal discharge 225; vomitus 153, 195, 314, 471, 477; weight loss 50, 153 syringe driver 464–6 table edge responses 321–3, 359–60 tail dressing 550 tarsal joint: access to 301, 312; intraarticular injection 427; osteochondrosis dissecans (OCD) 289; X-ray findings 289 taste test 332, 335, 337, 339 tear swab sample 365 teats palpation 227–8 tension views (X-ray) 347 testicle cross section 242 third-degree AV-block 84–5 thoracic dressing 548 thoracic effusion 127 thoracic percussion areas and technique 118–19 thoracic spine: X-ray 346–7 thoracocentesis 508–11; cardiological 109–10; respiratory 151–2 thrombembolism 126 through-the-needle catheter 437–40 thymoma 127 thyroid palpation 52, 54–6 tibialis anterior reflex 328 tibial nerve 343 tissue sample biopsy 26–8 tonic neck reaction 321–3 tonometry 370–1 Tonopen® tonometry 370–1 topical anaesthesia 367, 450 tracheal collapse 124 tracheal foreign body 124 trachea palpation 53–6 tracheo-bronchial lavage 145 tracheo-bronchoscopy 135–7 tracheotomy 489–91 transfusion 467–81; autotransfusion 479–81; full blood transfusion 467–77; preserved blood units preparation 477–8; volume 469, 474 transport 4 transthoracic biopsy of the lung 143–4 transtracheal lavage 149–50

treatment methods: bandages 542–68; drainage 508–22; flushes 523–41; infusion 453–66; inhalation 482–92; injection 415–32; parenteral nutrition 493–9; transfusion 467–81; urinary catheter 500–7; venous access 433–52 triceps/forelimb muscle injection 418 triceps reflex 324, 326–8 tricuspid valve insufficiency 100 trochanteric fossa 450 true-cut biopsy 189 tumours: biopsy 188, 412–13; fine needle aspiration biopsy 412–13; heart 102; intestines 170; mandibular 279; nasal cavity 124; osteolytic digital 282; ovarian 230; pulmonary 126; splenic 169 tympanic bulla 390 tympanic membrane 388 ulcus 398 ulnar nerve 341 ultrasound examination: andrological 241–2; cardiological 88–104; gastrointestinal 183–6; gynaecological 232–4; opthalmological 379–80; orthopaedic 303; urological 208–10 umbilical hernia 168 unilateral renomegaly 200 unilateral thoracic effusion 127 ununited anconeal/coronoid/medial coronoid process 285–6 ureters visualisation 202 urethral lavage: flushes 538–41 urethro-cystoscopy 206 urethrography 204–5 urinary bladder: biopsy 211–13; palpation 196; ultrasound 208 urinary catheter 215–21, 500–7; females 218–21; males 215–17 urine chemistry 40, 45 urine samples processing 40–5 urological examination methods 195–224; abdominocentesis 223–4; biopsy 211–15; case history 195; contrast medium study 202–5; cystocentesis 221–2; endoscopy 206–7; inspection 195; palpation 196–7; ultrasound examination 208–10; urinary catheter 215–21; X-ray study 198–201 uterus: cross section 233; palpation 227 vaginal smear 235 vaginoscopy 231 Velpeau-sling bandage 566

INDEX

venotomy 435, 447–9 venous access 433–52; central venous catheters 437–49; intraosseal 450–2; peripheral venous catheter 433–6 venous blood sampling 11–13 venous catheter 434–5, 437–46, 514–15; modified 519 ventricular ectopic complex 78, 82–3, 87, 112, 513, 515 ventricular fibrillation 78, 83 ventricular septal defect 101 ventricular tachycardia 78, 83, 87 vertebral spine: X-ray 345 vitreous body 377, 381–2; injection 431 vulva palpation 227–8

577

wart/papilloma 398 wheal (urticaria) 395 wheelbarrowing responses 319–23 withdrawal reflex 325, 327–9 Wobbler syndrome (X-ray) 347 wood-lamp examination 405 X-ray study: andrological 240; cardiological 63–70; gastrointestinal 165–72; gynaecological 229–30; neurological 344–7; opthalmological 378; orthopaedic 265–97; otological 390; respiratory 124–8; urological 198–201 xylazine 87